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.
Job Description
- 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 housemanship.
- 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 openess to working shifts including occasional weekends.
- Strong medical and clinical knowledge and experience.
- Excellent interpersonal and communication skills.
Benefits
- Work alongside & learn from best-in-class talent
- Join a market leader within the health Insurance space
- Work remotely
- Fantastic work culture
- Great work-life balance
