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Claims Operations Associate
Reliance Health
Operations
Cairo, Cairo Governorate, Egypt
Posted on Oct 7, 2024
Reliance Health’s mission is to make quality healthcare delightful, affordable, and accessible in emerging markets. From Nigeria to Egypt and now Senegal, we offer comprehensive health plans tailored to both employers’ and employees’ needs through an integrated approach that includes telemedicine, affordable health insurance, and a combination of partner and proprietary healthcare facilities.
By leveraging advanced technology, we are transforming the healthcare landscape, making it more efficient and accessible for everyone.
This role is 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 Provider reconciliation .
Claims Examination
- Receive and save claims documents.
- Follow standard procedures to handle Healthcare Providers' Claims.
- Investigate complex claims and reach resolutions based on company policy and medical standards.
- Ensure high-quality management of claims.
- Take part in provider reconciliation and resolving complaints.
Fraud Detection
- Reject fraudulent Healthcare Providers' Claims and provide reasons for the decision.
- Investigate suspected cases of fraud, waste, and abuse, and prepare a report supported by evidence for final review by claims and provider operations leads.
Documentation and Process Review
- Work with Provider Operations for tariff agreement.
- Update the data of claims on an Excel sheet.
- Follow up on claims payment with the finance team.