Medical claims Officer - MCC

Job description

Description:

The Medical Claims - Officer will provide quality service to clients, promptly and effectively assesses and process OP claims according to operations set standards

Key responsibilities/What you do:

• Manages routine daily claims administration work. 
• Coordinates work flow & meet deadlines.
• Evaluates OP claims with regards to eligibility.
• Apply nextcare cost containment protocols for OP claims at the retrospective review level
• Attends calls and e-mails from insurance companies, clients, and providers.
• Makes suggestions to improve service.
• Increase efficiency, minimize errors, and reduce administration time through AI-powered automation.

AI READINESS Work effectively in an environment shaped by artificialintelligence (AI), machine learning, data analytics and cloud-based tools, using insights responsibly with our standards of data governance, security and ethical use.

Key requirements/What you bring

• Bachelor’s of Pharmacy / Dentistry / Medicine / Nursing / Physiotherapist / Paramedics
• Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus) OR Entry Level
• Physically fit to carry out duties.
• Certified Medical Coder [Preferable]
• Legally permitted to work in the country of operations.
• Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills
• Certified Medical Coder is preferable, with familiarity in AI-driven coding tools being beneficial
• Experience with AI tools and platforms relevant to claims processing and administration, enhancing operational efficiency and accuracy.

How we hire Allianz Partners does not accept unsolicited CV’s or approaches from agencies. We only work with partners on our approved supplier list, under contract. Any unsolicited submission will not be considered