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Medical Claims Officer

2 months ago

Dubai, United Arab Emirates Allianz Partners Full time

**Summary**

The Precertification Officer is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers with high efficiency and within the agreed turnaround time to maintain the team KPIs.

**Main Tasks**
- Assesses approval of medical approvals as well as policy use.
- Checks particular treatment plan is necessary for the patient.
- Inputs verbal and written claims approvals regularly.
- 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.
- Coordinates workflow & meet deadlines.
- Evaluates claims concerning eligibility.

**KPIs of Primary Responsibility**

**Claims Officer
- Precertification**

**Productivity 30%**

Meet daily Precertification productivity target according to claims type/tenure.

**Service level 30%**

Adjudicate Outpatient Precertification on First in First out basis.

Maintain Productivity TAT of 85% in 10 minutes and 98% within 1st hour and immediate for

Emergency/ VIP

**Quality 30%**

Claim adjudication With NO Financial or Potential financial Error

Claim adjudication With NO Technical Error following the publish adjudication rules.

**Attendance and punctuality 10%**

Adherences 100% to Schedule and Punctuality.

**Main Requirements**
- Bachelors of Medicine - Pharmacy.
- 2+ years Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus).
- Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.

**Job Level**:
Professional

**Location**:

- Dubai, AE**Area of Expertise**:
Operations

**Unit**:
Allianz Partners

**Employing Entity**:
NEXTCARE Claims Management LLC

**Job Type**:
Full-Time

**Remote Job**:
Hybrid working

**Employment Type**:
Permanent

**ID**:
36201

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