The Claims Operations Associate is responsible for managing claims and approvals processes, and the scope of work includes vetting health insurance claims and approval from service providers, reconciling payments and negotiating and uploading claim tariffs.
Key Responsibilities
Examine and approve or reject healthcare providers’ claims to meet set targets.
Investigate claims for fraud, waste, and abuse.
Promptly resolve escalated approval requests for care.
Negotiate tariffs and update the providers’ dashboard and execute other elements of tariff management.
Collaborate with the technology team to improve the processes claims, tariff and approvals management system.
Collaborate with customer success and provider relations teams to ensure customer satisfaction goals.
Minimum of a first degree in medicine, nursing or pharmacy and completion of internship or houseman ship.
Previous experience in a claim examiner role is a major advantage.
Excellent numeracy, analytical and problem-solving skills.
A high-level of responsiveness is essential and openness to working shifts including occasional weekends.
Strong medical and clinical knowledge and experience.
Excellent interpersonal and communication skills.
Renumeration: 250k - 300k
Join a market leader within the Insurance space
Unlimited leave days
Fantastic work culture
Work and learn from some of the best in the industry
Great work-life balance
...As an Assistant Interior Designer, you will work on a fabulous and fun team of other talented designers, receive support from a mentor,... ...reports. Support the contracts process by collaborating with internal teams to ensure design deliverables align with contract...
...Role: QA Tester Location: 100% Remote Duration: Long-term contract What You'll Do: Perform manual testing for web and mobile applications Identify, document, and track bugs Validate functionality, usability, and performance Work...
...meetings and others as applicable. Consults with FMS Corporate Dietitian regarding nutrition concerns as needed. Maintains and... ...SUPERVISION: ~ None EDUCATION AND REQUIRED CREDENTIALS : Registered Dietitian as per Commission on Dietetic Registration Board...
...problem-solver looking for a strategic consulting role that blends leadership, technology,... ...contributing to the growth and success of the firm. You will serve as a trusted advisor to... ...ability to navigate organizational politics and drive consensus among diverse stakeholders...
...GENERAL JOB DESCRIPTION Sr. Project Manager Piper Electric Co., a Crete United Company , is seeking an experienced Project Manager to lead commercial and industrial electrical construction projects from turnover through completion and close-out. This role is responsible...