Claims Operations Associate (Contract) New Job at Reliance Health, Remote

ay95cDMxZHlET3ZzTUxkRGpTZUR4dEt0MUE9PQ==
  • Reliance Health
  • Remote

Job Description

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.

Requirements

  • 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

Benefits

  • 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

Job Tags

Remote job, Contract work, Internship,

Similar Jobs

Wetalentia

Sales Engineer Job at Wetalentia

 ...SALES ENGINEER Southeast United States Location: TN, NC, SC, GA, FL (Southeast Region) Industry: Measurement, Inspection...  ...process control within workshop environments, is seeking a Sales Engineer to support its growth plans in North America. The organization... 

Always There Personnel

Assembly (Entry Level) Job at Always There Personnel

 ...NOW HIRING ASSEMBLY POSITIONS IN BLUM, TX! NO EXPERIENCE NEEDED | TRAINING PROVIDED! Location: Blum, TX Must be able to commute in under 1 hour Temp-to-Hire | OT Available (not mandatory) Assembling Shape Charges & demolition work ~ T4 Shift| Sun-Wed |... 

Edgewell Personal Care Brands, LLC

Production Operator - Pre-Grind (Night Shift 7:30pm - 7:30am) Job at Edgewell Personal Care Brands, LLC

Edgewell is a global team of over 6,000 visionaries, doers and makers. Our secret is people, and we have an inspiring and collaborative global force of them. Our portfolio of over 25 brands touches lives in more than 50 countries by making useful things joyful. Together...

Mansions at Acqualina

Mansions Residential Receptionist Job at Mansions at Acqualina

 ...experience as Reception Agent, Security Officer or both. Previous cashiering experience. Fluency in a foreign language, preferably Spanish/Russian/Portuguese. Ability to suggestively sell. Certification of previous training in computers. Certification of... 

Top Level Promotions

Office Administration Assistant - Work from Home Job at Top Level Promotions

 ...Work from Home Data Entry & Office Administration Remote Online Role About the Job We are seeking motivated individuals in Lancaster, Pennsylvania, United States , for an entry-level remote position in data entry, office administration, and online research...