Description
This role is responsible for supervising and managing the manual claims and tariff processing team to ensure the claims submitted by our providers are processed and paid promptly and efficiently, and they are error and fraud-free.
Responsibilities:
Provide supervisory and technical support to the manual claim operations team
Receive and review approved claims from claims operation associates for final approval and payment
Investigate complicated claims and pass resolutions based on company policy and clinical standards of care
Distribute operational tasks across the team to meet objectives
Quality assurance for claims management
Oversee the hiring and training of claims operation associates
Work with technology team on any update on the processes or products for claims and provider management
Audit and update the standard procedure for claims management and other related SOPs for improved performance
Provide the divisional lead with regular updates on manual claims operations
Process healthcare providers’ claims using the claims management process standard procedure
Participate in provider reconciliation and complaint resolution
Requirements
Minimum of a first degree in medicine, nursing, or pharmacy
At least three years of experience in a claim examiner/assessor role
Excellent numeracy, analytical and problem-solving skills
Strong medical and clinical knowledge and experience
Excellent interpersonal and communication skills
Leadership and management skills
Benefits
Work alongside & learn from best-in-class talent
Join a market leader within the Insurance space
Attractive Salary & benefits
Unlimited leave days
Free office lunch
Fantastic work culture
Work and learn from some of the best in the industry
Great work-life balance