Senior Medical Claims Officer

Allianz Partners

Senior Medical Claims officer provides quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards.

Senior Medical 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.

What You Do

• Assesses approval of medical approvals as well as policy use.
• Channels Medical 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.
  
  

What You Bring

• Bachelor s of MedicinePharmacyDentistry
• 2+ years Medical Practical Experience (reputable insurance provider, broker or a TPAexperience 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 generalinternet navigation and research skills.