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
...~ Must have a reliable insured vehicle for travel to family homes. ~ Minimum age of 18, valid drivers license ~ Hold a high school diploma/GED ~ CPR trained or willing to receive training. If this sounds like something you are interested in, please apply...
...reliable, and affordable energy a reality by pushing the boundaries of what is possible. As a leading player in the wind industry and manufacturer of wind turbines, we are passionate about driving the energy transition and providing innovative solutions that meet the growing...
...This job was posted by : For more information, please see: City of Portland - Senior Planner Planning & Urban Development **About the City of Portland (ME) Department of Planning & Urban Development:** The Department of Planning and Urban Development...
...Reliable, punctual, and trustworthy Must be able to lift up to 25 lbs. and stand for extended periods Ability to work Saturday & Sunday 8:00 am to 4:30 pm What We Offer: Supportive team environment Competitive hourly pay Opportunities for additional...
...in US) Responsibilities Lead full-chip and block-level physical design for advanced semiconductor products across multiple technology... ...physical design deliverables for manufacturing readiness. Mentor engineers influence best practices and contribute to technical roadmap...