Claims Operations Associate

Summary

Join a market leader within the health insurance space as a Claims Operations Associate, responsible for managing claims and approvals processes.

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 openness to working shifts including occasional weekends
• Strong medical and clinical knowledge and experience
• Excellent interpersonal and communication skills

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

Benefits

• Work remotely
• Fantastic work culture
• Great work-life balance