Medical Claims Officer

Job description

Overview

·   Claims Pre-certification and Adjudication with compliance to established Policy Guidelines as well as managing & providing overall guidance about Medical Cases review & authorization over Phone.
·   Responding to queries regarding cover, claims, hospitalization, complaints
·   Commit to the department`s service standards across phone, email, live chat, and customer experience metrics such as customer satisfaction and NPS.
·   Multi-tasking of daily assigned workload as well as ad hoc assignments and follow up on individual cases.
·   Develop extensive and sound product knowledge to provide timely and accurate information to our clients.
·   Responsible for providing outstanding customer service to clients and ensuring customer satisfaction and retention.

 

 Key Responsibilities/ what you do

·  Manages routine daily claims administration work. 
·  Coordinates work flow & meet deadlines. 
·  Evaluates claims with regards to eligibility. 
·  Takes decisions on high cost and complicated cases based on standard operating procedures. 
·  Handles International Preauthorization cases as required. 
·  Attends calls and e-mails from insurance companies, clients, and providers.
·  Coordinates with international providers for direct billing.
·  Makes suggestions to improve service.
·  Increases efficiency, minimizes errors and administration time. 

 

Minimum Requirements/ What you bring 

·  Bachelor’s of Medicine (MBBS)
·  Medical 1 year Practical Experience in UAE claims, DRG claims and coding skills (reputable insurance provider, broker or a TPA experience a plus).
·  Legally permitted to work in the country of operations.
·  Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills

     We are Allianz Partners. The leader in assistance and insurance solutions in the areas of international health, assistance, automotive and travel insurance. Allianz Partners is a global family of over 19,000 employees across 78 countries. This role is in the International Health part of the business, which has a number of well-known customer facing brands such as Allianz Care, Nextcare and Medi24.

The International Health line of business provides international health, life and disability insurance and services, reinsurance and administration services to a wide range of customers. These include multinational companies, intergovernmental organisations (IGOs), non-governmental organisations (NGOs), private individuals, families and students. Our mission is to ensure that customers have access to quality healthcare through our support, care and commitment to go the extra mile. We are a truly global health partner for our customers, ensuring fast and simple access to the best advice, treatment and value for our customer