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
...Do you have merchandising and/or handbag experience and free time each month you would like to turn into supplemental income? This could... ...Merchandise COACH handbags and footwear according to current visual directives Create and commit to a monthly cadence of visits...
...Job Description Job Description The Kraft Heinz Company is currently seeking an Industrial Mechanic to work at our facility in Davenport, Iowa. Ideal candidates must be safety and quality oriented and be willing to work in a team oriented, fast paced, refrigerated...
...DESCRIPTION Amazon is looking for an experienced Studio Operations Manager to supervise the Studio Operations team, in person, in a commercial photography studio environment. As the Studio Operations Manager, you oversee a team that handles the workflow of high volumes...
Enhance the ALDI customer shopping experience in a collaborative team environment as an ALDI Cashier or Stocker. As a member of our team, youll be operating the registers or other machinery, stocking our shelves, keeping our stores looking their best, and serving our customers...
...primary purpose of your job position is to provide assistance in all dietary functions as directed/instructed, in accordance with established... ...waste, diseases, conditions, etc., including exposure to the AIDS and Hepatitis B viruses. Maintains a liaison with other...