Claims Operations Associate (Contract)

Claims Operations Associate

Reliance Health aims to redefine healthcare accessibility, affordability, and delightfulness in Emerging Markets. Leveraging technology, we've built an integrated health system comprising affordable health insurance, telemedicine services, and a network of partner and proprietary healthcare facilities. This enables us to offer innovative healthcare solutions precisely when our users need them the most.

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.

Key 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.
• 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.