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
- 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.
- 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
What We Do
We use technology to make quality healthcare delightful, affordable, and accessible in emerging markets.
Since 2016, we have worked to combine the power of technology and data with the passion and dedication of a talented group of people devoted to providing great quality healthcare to regions that have typically been overlooked.
We do this by building an integrated healthcare system where we receive easy install mental payments from individuals and businesses and provide them healthcare through a combination of platforms, services and a fleet of modern clinics we operate alongside other third-party clinical partners.
