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
...Join Our Team as a Leasing Agent Do you love connecting people with their perfect home? As a Leasing Agent at Tonti Properties, you'... .... What We're Looking For: Minimum of 1 year of leasing experience required Must be proficient in word processing, data entry...
...Independent Route Delivery Contractor Belmont, New Hampshire Service Area: Belmont, NH 03220 Position Type: Independent Contractor (1099) Daily Pay: $100 per route day Start Date: Immediate West Franklin Investments LLC is seeking dependable, self-motivated...
...benefits _______________________________________________________________________ Enterprise Electrical is seeking a skilled and experienced Electrical Senior Project Manager to lead large-scale Mission Critical Data Center Projects in Cedar Rapids, Iowa, and other...
...client, a leader in Medical Device Manufacturing, is seeking a 3D Model Finisher to join their team. As a **3D Model Finisher** , you... ...across a wide range of industries and skills. Our expert family of brands -_ **_Manpower, Experis, Talent Solutions, and Jefferson Wells_*...
...old, You should also be comfortable with light house management. Pay: $30 per hour Start date: ASAP Hours:6:30am-2pm Saturday and Sunday, Guaranteed 17 hours every weekend Looking for a long term commitment Requirements : Valid driver's license and...