Portfolio Jobs

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