Claims Management Processor
1 month ago
The Claims Management - Assessor will provide quality service to clients by promptly and effectively assessing and processing claims and approval according to operations set standards for direct type of claims.
**What you do**
- Evaluates claims with regards to eligibility and medical necessity if required.
- Ensures that insurance claims information is entered into the system correctly, to ensure accurate processing and timely payment.
- Can Perform Direct Claims Documents handling tasks including claims tracking, payment order generation and releasing.
- Ensures that provider’s fees and service items charges coincide with their existing contract price list with Nextcare.
- Ensures the accuracy of the entered data as per the existing standard steps and procedures of direct claims processing.
- Screens claim documents and process claim adjustment.
- Ensures Payment Orders are properly created and forwarded accordingly for final documentation and filing.
- Ensures adaptability in various claims handling work-related tasks (e.g. claims reconciliation review, claim correction, etc.) to be able to facilitate a multi-tasking role.
- Ensures that high quality standard of work performance is achieved at all times.
- Stands as a reference person for information on inquiries concerning claims processing procedures.
- Makes sure that claims are properly audited of all data entered with accurate medical claims details.
- Notes all discrepancies during the course of the system process are properly forwarded and notified to immediate supervisors and concern units.
- Provide requisition of office supplies for Individual and Team requirement.
**What you bring**
- Attention to detail and ability of multi-task.
- Organizational & time management skills.
- Excellent team player.
- Ability to meet tight deadlines.
- Ability to work under pressure to tight deadlines.
- Strong communication skills.
- Ability to work well with all levels of internal management and staff, as well as outside clients and users.
- Ability to demonstrate sounds work ethics.
- Show flexibility with excellent interpersonal skills.
- Flexible to work in shifting schedule.
- Bachelor’s degree ( Nursing ), with at least 2 years of clinical experience background preferred.
- 3+ years filing/documentation experience. Experience within the Health Care Industry, TPA’s, insurance companies, Hospitals, Medical Centers is 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.
**What we offer**
Our employees play an integral part of our success as a business. We appreciate that each of our employees are unique and have unique needs, ambitions and we enjoy being part of their journey. We are there to empower you and your professional and personal goals and for that reason here are some of our benefits:
- Dynamic and Multinational working environment
- Trainings and programs dedicated to Learning and Development (e.g. free access to LinkedIn Learning)
- A wide range of employee benefits such as performance bonus, health insurance.
- Modern Offices
60921 | Customer Services & Claims | Professional | Non-Executive | Allianz Partners | Full-Time | Permanent
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.
Join us. Let's care for tomorrow.
**Job Level**:
- Professional
**Location**:
- Dubai, AE**Area of Expertise**:
- Customer Services & Claims
**Unit**:
- Allianz Partners
**Employing Entity**:
- NEXTCARE Claims Management LLC
**Job Type**:
- Full-Time
**Remote Job**:
- Hybrid working
**Employment Type**:
- Permanent
**ID**:
- 60921
**Position Cluster**:
- Non-Executive
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