Claims Operations Associate (Contract)

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Requirements:

• Minimum of a first degree in medicine, nursing, or pharmacy.
• Completion of internship or houseman ship.
• Previous experience in a claim examiner role is an advantage.
• Excellent numeracy, analytical, and problem-solving skills.
• High responsiveness and willingness to work 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 within tariff management.
• Collaborate with the technology team to enhance claims, tariff, and approvals management processes.
• Work with customer success and provider relations teams to ensure customer satisfaction.