Offer summary

Qualifications:

First degree in medicine, nursing or pharmacy, Completion of internship or housemanship, Experience in a claim examiner role, Strong medical and clinical knowledge, Excellent numeracy and analytical skills.

Key responsabilities:

Manage claims and approvals processes

Examine and approve or reject healthcare claims

Investigate fraud, waste, and abuse

Negotiate tariffs and manage provider dashboard

Collaborate with teams for customer satisfaction

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.

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