Claims Operations Associate – Remote Position

Claims Operations Associate

Join our dynamic team as a Claims Operations Associate and play a crucial role in managing health insurance claims and approvals. We are looking for someone experienced in handling healthcare claims, negotiating tariffs, and managing the approvals process. This is a remote position that offers flexibility and the opportunity to work alongside best-in-class talent in the health insurance space.

Job Description:

As a Claims Operations Associate, your primary responsibilities will include the following:

• Examine and approve or reject claims from healthcare providers to ensure they meet company targets and standards.
• Investigate potential fraud, waste, and abuse in health insurance claims, ensuring the accuracy and integrity of the claims process.
• Resolve escalated approval requests for medical care promptly, ensuring that both service providers and clients receive timely responses.
• Negotiate tariffs with healthcare providers, updating their dashboards accordingly and executing other aspects of tariff management.
• Collaborate with the technology team to enhance the efficiency of claims processes, as well as improve the overall system for tariffs and approvals management.
• Work closely with customer success and provider relations teams to align with customer satisfaction goals and maintain excellent relationships with service providers.

Requirements:

• A minimum of a first degree in medicine, nursing, or pharmacy, along with the completion of an internship or housemanship.
• Previous experience as a claims examiner is highly advantageous.
• Strong numeracy, analytical, and problem-solving skills are essential to succeed in this role.
• The ability to respond swiftly to tasks, with openness to working shifts, including occasional weekends, is required.
• Solid medical and clinical knowledge is critical, as is experience in the healthcare field.
• Excellent interpersonal and communication skills to liaise effectively with team members, providers, and clients.

Benefits:

• Work alongside and learn from best-in-class talent in the health insurance sector.
• Be a part of a market leader in health insurance, offering great professional growth opportunities.
• Remote working opportunity with a flexible schedule.
• Enjoy a fantastic work culture that prioritizes work-life balance.

If you are interested in joining a leader in the health insurance industry and meet the above qualifications, we encourage you to apply!

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