Senior Medical claims officer - Pharmacist/physician

Job description

Senior claims officer provides quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards.
 
Senior claims officer is also responsible for team success by agreeing, implementing and monitoring individual and team objectives and targets ensuring company policies and procedures are adhered to.

Key responsbilites/what to do
Assesses approval of medical approvals as well as policy use.
Channels claims officers in handling difficult medical cases and optimize the quality and quantity output.
Monitors daily output on the number of case done and decrease in number of errors committed.
Checks particular treatment plan is necessary for the patient.
Inputs verbal and written claims approvals regularly.
Provides second opinion for cases where there is doubt in treatment plan.
Decides approvals as per policy conditions.
Assess high cost claims and provide decision on high cost and complicated cases. 
Provides clear feedback on queries from call Centre team.
Provides clients an understanding of any declined medical claims.
Manages routine daily claims administration work. 
Coordinates work flow & meet deadlines. 
Evaluates claims with regards to eligibility. 
Provides on job training to team members as necessary.

Strong verbal and written communication skills.
Show flexibility, excellent interpersonal skills. 
Team Player.
Attention to detail and quality.
Ability to work well with all levels of internal management and staff, as well as outside clients and users.   
Ability to train other staff. 
The ability to communicate sensitively and effectively with claims department and other departments having regard for the strict need for confidentiality. 
Experience of working with senior managers and understanding the necessity to act in a pleasant and courteous manner and to be able to work effectively with others.
The ability to exercise initiatives and be able to work flexibly under pressure and to tight deadlines.

Customer & Market Excellence: 
Strive for excellence at every touch point with the customer
Foster state-of-art  technical/operational knowledge and strive for continuous simplification
Be the benchmark
Collaborative Leadership:
Empower the team and provide purpose and direction
Develop people, provide  feedback and care to employee wellbeing
Collaborate and exchange best practice.
Entrepreneurship:
Act on opportunities, anticipate trends, take risk, and promote a culture that allows for honest failure
Take ownership and responsibility
Embrace innovation and a culture that allows to make decisions without fear of retribution.
Trust:
Act with integrity, honor commitments, tell the truth
Foster diversity and inclusiveness
Act transparently and promote corporate social responsibility.

Key requirments/what to bring:
Bachelor’s of Medicine  ( MBBS )
2+ years Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus).
Physically fit to carry out duties.
Legally permitted to work in the country of operations.
Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.
 

69745 | Customer Services & Claims | Professional | PG08 | Allianz Partners | Full-Time | Permanent

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