Senior Claims Associate

We’re a health insurance company that acts like a technology company. We’re using software, data science and telemedicine to make health insurance more affordable, easier to access and more of a delightful experience
Job Title: Senior Claims Associate
Reports to: Team Lead, Claims and Analytics
Expected Start Date: Q2 2020
The Candidate
The ideal candidate for this role is someone with a start-up mentality who is ready to work hard and push the limits in ensuring claims vetting and management process is a success.
The Senior Claims Associate will be responsible for vetting all claims submitted by our Providers to ensure they are error and fraud free
They will manage claims payment and be involved in the resolution of medical cases requiring special attention.

Key Responsibilities
Examine Healthcare Providers’ Claims using the Tariff agreement to determine authenticity and payment.
Decline fraudulent Healthcare Providers’ Claims, and state causative reasons.
Forward approved Claims to Team Lead for review and final approval.
Investigate complicated Claims and escalate to Team lead, if necessary.
Carry out physical inspection at the assigned provider’s office using the checklist.
Investigate complicated claims by checking the case folder and speaking to the Enrollee and the doctor.
Escalate fraudulent cases to the Committee of Doctors.
Update Providers’ dashboard, and implement resolutions.
Relate with the Customer success team to manage concession requests.
Relate with technology and design team on any update on the processes regarding the claims of Healthcare Providers.
Relate with Provider Relations Service unit for tariff agreement.