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
...Adult Psychiatrist 1620100% OUTPATIENT, NO CALL *Location, Location, Location!!!*If you are looking for a midsize city to make your home and establish lifetime roots then this place is for you!*This CMHC agency has a need for an Adult Psychiatrist due to growth...
...Urgent Opportunity: Dynamic District Manager at Zaxby's Do you thrive in a fast-paced environment where your leadership can make a real difference? Are you looking for a role that offers both challenge and reward ? If so, Zaxby's wants you! DEFINITION Our District...
The Role: Key Responsibilities Include: Conduct investigative research into current dynamics in geopolitical dynamics, trade & tariff policies, international relations, defense and security, and intelligence ; Track ongoing events including legislation, negotiation...
...Mature/Dependable person to fill an evening Cleaning position in a building in the Warren... ...part time employment in the evenings and weekends. Requirements: 1). Criminal... ...employees job satisfaction from cleaners to office staff to management. Our goal as a company...
...With world-wide sales of $15 billion and a global company employing nearly 45,000 associates, Ecolab is a trusted partner at more than one million customer locations. Ecolab (ECL) delivers comprehensive solutions and on-site service to promote safe food, maintain clean...