Senior Claims processing officer

Job description

Main responsbilites/ What to do

•    Responsible for training of new Claim officers for both Clinic & Standard Claim.
•    Handles regular monthly Audit of both DB and RI team along with targeted Audit
•    Provides periodic team update on claim processing and guidelines for both Clinic & Standard Claims.
•    Scrutinize Audit results and provide recommendations to the Claims Team Leader and to individual CO. 
•    Handle Suspicious cases co-ordinating with the global team and also contacting the member and provider when required.
•    Responsible in handing Underwitten policies and reporting.
•    Handle queries from TPA, CRM and providers.
•    Aid in Reconciliation and Resubmission on Direct Billing Claims.
•    Support processing team and assist requests from Escalations such as contacting the provider in UAE and outside.    
•    Ad Hoc in processing claims. 
•    Knowledge on TPA Processes and support on the queries along with maintaining the trackers. 
•    Knowledgeable in DHA and HAAD Circular update.
•    Align with Global counterparts identifying the gaps. 
•    Build AI training modules for the new claims officers 

 80860 | Customer Services & Claims | Professional | Non-Executive | Allianz Partners | Full-Time | Permanent