Treatment Guarantee and Pre-Certification Officer - Allianz - Makati

Job description

As an International Health Insurance Consultant – Treatment Guarantee and Pre-Certification Officer, your key responsibilities will include:

Reviewing and assessing health insurance claims for international healthcare services, ensuring compliance with policy terms, conditions, and regulatory requirements.
Analyzing medical reports, invoices, and supporting documents to determine claim eligibility and coverage levels.
Processing and adjudicating claims with accuracy and efficiency, adhering to established procedures.
Communicating with insured individuals, medical providers, and stakeholders to gather additional information or clarifications, ensuring timely and accurate resolution.
Issuing Treatment Guarantee Documents to Providers and Insured Persons as per the guidelines established for Treatment Guarantee
Managing complex claims, including those related to chronic illnesses, pre-existing conditions, and high-cost treatments, ensuring fair and equitable handling in line with policy guidelines and industry best practices.

Important to your success

Strong ability to plan, prioritize, and organize tasks while managing competing resources and demands.
Team player with a willingness to support a collaborative and supportive culture.
Excellent verbal and written communication skills, with the ability to balance empathy and compassion with achieving the best commercial outcomes for Allianz Partners.
Ability to deliver superior customer service to a range of internal and external stakeholders.
Proficiency in multitasking and working in a fast-paced environment.
High attention to detail and pride in work accuracy.
Confidence in learning, accessing, and utilizing various systems and software applications.
Empowered decision-making skills.
Technical experience in thoroughly investigating and interpreting claims and refund outcomes to communicate effectively with customers.
Experience in the financial or insurance sector is a plus.
Strong problem-solving and analytical skills.
Effective time management and multitasking abilities.
Positive and flexible team player, contributing to a dynamic customer service team.
Ability to self-manage performance against business requirements.
Commitment to personal development and continuous learning

Responsibilities

Deliver exceptional customer service by promptly addressing inquiries and resolving issues related to claims, policy coverage, and reimbursements.
Keep up-to-date with industry trends, regulatory changes, and best practices in claims management and international healthcare to ensure compliance with relevant laws and regulations.
Contribute to the continuous improvement of claims processes, systems, and workflows by providing feedback, identifying enhancement opportunities, and actively participating in improvement initiatives.
Maintain accurate records and documentation of claims, ensuring confidentiality and data privacy in line with company policies and regulatory requirements.
Work collaboratively with cross-functional teams, including customer service, sales, and finance, to ensure a seamless claims experience and efficient settlement for insured individuals.
Engage in training and development programs to enhance knowledge of international health insurance, claims management, and industry practices.
Adhere to quality standards, service level agreements, and performance metrics, consistently meeting or exceeding targets for claim accuracy, turnaround time, and customer satisfaction.

Personal Attributes

Bachelor’s degree in any field
Experience in any Financial / Insurance related field is a plus
Strong attention to detail, proven problem solving and analytical skills
Ability to multitask and manage time effectively
Positive and flexible team player, willing to contribute to a dynamic customer service team
Ability to self-manage performance against business requirements
Commitment to personal development and ongoing learning
Capable to work onsite for first 6 months; hybrid after
Amenable to follow client specific schedule and holiday
Open to Adhoc tasks