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
...DOLA Only - Division of Local Government - Regional Manager - (Reallocation) Print ( Apply ? DOLA Only - Division of Local Government - Regional Manager - (Reallocation) Salary $10,800.00 - $11,163.00 Monthly Location Statewide, CO...
...StretchLab is seeking B.S. in Exercise Science, Kinesiology and Athletic Training to join our team for three of our studios in Triangle area- Cary, Morrisville, and Holly Springs, NC. This is an amazing opportunity to gain experience in a new modality that is taking the...
$10,000 Sign-on Bonus full-time He/she performs diagnostic ultrasound exams as ordered under the supervision of a radiologist. He/she will train personnel as directed by Imaging Services Department Manager or Director. Responsibilities Performs ultrasound studies...
JOB DESCRIPTION: $125K-$150K SEEKING COMMERCIAL DRYWALL PROJECT MANAGERS & ESTIMATORS GPAC: #1 Commercial Drywall Recruiting Firm in North America: WORK FOR A LEADING CONTRACTOR I am working with multiple well-respected, firmly established Commercial Drywall Contractors...
...Screen reader users may encounter difficulty with this site. For assistance with applying, please contact ****@*****.***... ...profile as it will transfer to your application. Job Title:Curator Department:EHE | Human Sciences Administration The...