Job Description
As a Claims Operations Associate at Reliance Health, you will manage claims and approvals processes, including vetting health insurance claims, reconciling payments, negotiating, and uploading claim tariffs. Your role is crucial in ensuring that claims are processed accurately and efficiently.
Job Title: Claims Operations Associate
Location: Fully Remote (Nigeria)
Key Responsibilities
- Claims Examination: Approve or reject healthcare providers’ claims to meet set targets.
- Fraud Investigation: Investigate claims for fraud, waste, and abuse.
- Escalation Resolution: Promptly resolve escalated approval requests for care.
- Tariff Negotiation: Negotiate tariffs, update the providers’ dashboard, and manage other elements of tariff management.
- Process Improvement: Collaborate with the technology team to enhance claims, tariff, and approvals management systems.
- Customer Collaboration: Work with customer success and provider relations teams to meet customer satisfaction goals.
Requirements
- Educational Background: Minimum of a first degree in medicine, nursing, or pharmacy and completion of internship or housemanship.
- Experience: Previous experience in a claim examiner role is a major advantage.
Skills
- Excellent numeracy, analytical, and problem-solving skills.
- High-level of responsiveness and openness to working shifts, including occasional weekends.
- Strong medical and clinical knowledge and experience.
- Excellent interpersonal and communication skills.
Benefits
- Professional Development: Work alongside and learn from best-in-class talent.
- Industry Leadership: Join a market leader within the healthcare space.
- Remote Work: Enjoy the flexibility of working remotely.
- Work Culture: Experience a fantastic work culture.
- Work-Life Balance: Benefit from a great work-life balance.
How to Apply
If you are detail-oriented and passionate about the healthcare industry, we invite you to apply for the Claims Operations Associate position at Reliance Health.