Medical Claims Senior Assessor
Allianz
Posted on 24 Oct
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Nationality
Any Nationality
Gender
Not Mentioned
Vacancy
1 Vacancy
Job Description
Roles & Responsibilities
Key responsibilities/What you do:
- Review and assess medical claims for both inpatient and outpatient services to determine coverage eligibility and compliance with policy terms.
- Validate Diagnosis-Related Group (DRG) coding for inpatient admissions using ICD-10-CM and CPT standards, ensuring alignment with clinical documentation.
- Apply thorough knowledge of UAE healthcare billing regulations, including DHA, DOH, and MOH guidelines, to ensure claims meet local compliance standards.
- Identify and rectify incomplete or inaccurate claim submissions.
- Ensure all required documentation is present and properly coded aligning with policy guidelines.
- Notify payers regarding claims that exceed predefined financial thresholds, ensuring timely communication and resolution.
- Track and maintain both quantitative (volume) and qualitative (accuracy) metrics for claims processing.
- Achieve assigned daily processing targets while maintaining high levels of accuracy and efficiency.
- Collaborate with internal departments to resolve claim-related queries.
- Perform other responsibilities as assigned by the department lead, in line with the scope of the role.
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Allianz
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. Join us. Let's care for tomorrow.