Precertification Assistant Manager

Job description

The Precertification Assistant Manager is responsible to monitor performance, work with other members of the management team to ensure best practices are followed, and seek improvement to meet deadlines.

This role has the overall responsibility to maintain an atmosphere of mutual trust and support with the staff in order to ensure smooth flow of work processes, productivity and quality.

 

What you do:

·  Support the Department Manager in creating action plans in response to directives, and in achieving the best pattern for all workflows in the department.
·  Ensure policies and procedures are followed for early detection of errors and ensure they are rectified at an early stage.
·  Maintain records of errors and omissions of staff, to be monitored and discussed with the concerned on a one to one basis.
·  Manage / process claims targets and quality check of data & efficiency of the staff members according to operational measures.
·  Assist management through policies/ procedure establishment and review.
·  Maintain and report output and productivity of staff.
·  Review procedures to maintain the TAT and set KPI’S; generate productivity report to ensure smooth flow and TAT.
·  Report key performance areas in preauthorization direct claims. Prepare and maintain standard claims reports.
·  Provide claims coverage decisions as per escalation process; approve authorization according to the predefined levels of authority.
·  Supervise monthly team target outputs as well as individual performance in terms of authorizations processed.
·  Promote the best image for the company through the professional appearance and behavior and adhere to company standards and procedures.
·  Assist in creating action plans in response to errors/claims monitoring.
·  As required train and supervise staff.
·  Handle, evaluate, process and validate claims, with regards to eligibility as per policy terms and conditions & Nextcare claims procedure.
·  Monitor and participate in quality control reviews.
·  Communicate with clients/medical providers regarding authorization response; discuss the authorization’s details with clients and provide a high quality service, sympathetic support and both medical and procedural advice as appropriate in a professional demeanor within TAT.
·  Liaise closely with the Precertification Doctor and Precertification Manager in the pre-authorization of treatments and appropriate medical care for all in-patient claims and any other type of claim costly, suspicious or complicated whereby claim doctor medical approval and signature is required.
·  Deal with urgent situations involving insured members, families, insurance companies, hospital personnel and Nextcare.
·  •Responsible and accountable for the confidential, proper administration of insured member data as well as system, policy and medical information.
·  •Coordinate workflow & Meet deadlines.
·  •Assign individuals to specific job tasks in coordination with department manager
·  •In charge of reporting in writing to the Manager regarding complaints received by the claims department and relating to a specific communication and/or authorization process. Daily management of customer complaints and internal relations.
·  •Coordinate with other departments in pending issues related to claims.
·  To perform special assignments and/or duties as directed by Claims Manager.
·  Apply and respect Nextcare leadership principles and create an environment of open communication and continuous improvement.
·  Oversee team leaders and their team members to execute all claims department operations and ensure expedient claims handling and quality customer service delivery. 
·  Create professional atmosphere of mutual support among staff to maintain highest levels of organizational flexibility.
·  Provide professional leadership and direction to the functions within the precertification department
·  Maintain the productivity reports of the team members.
·  Delegate responsibilities in order to accomplish tasks on time.
·  Respond to customers by reviewing policy procedures
·  Ensure best practices are followed and continually seeks for improved processes
·  Build employees to be a client oriented focus, keep them motivated with support and directions.
·  Monitor and participate in quality control and reviews.
·  Communicate with other department managers pertaining to issues related to claims and vice versa
·  Develop and maintain beneficial working relationships with direct reports and peers and meet inter departmental deadlines.

What you bring:

·  Bachelors of nursing required
·  Minimum 2-5 years management experience within the Health Care Industry
·  Knowledge of overall insurance industry practices is a plus; the ability to exercise initiative and be able to work flexibly under pressure and to tight deadlines.
·  Legally permitted to work in the country of operations.
·  Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills
·  Physically fit to carry out duties and responsibilities.

56817 | Customer Services & Claims | Professional | Non-Executive | Allianz Partners | Full-Time | Permanent

Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams and challenges, is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow and to shape a better future for our customers and the world around us. 
We at Allianz believe in a diverse and inclusive workforce and are proud to be an equal opportunity employer. We encourage you to bring your whole self to work, no matter where you are from, what you look like, who you love or what you believe in.
We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, disability or sexual orientation. Great to have you on board. Let's care for tomorrow.