Medical Claims Officer
3 weeks ago
**Summary**
The Claims officer provides quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards.
**Main Tasks**
- Evaluates medical claims from the technical and medical perspectives as per policy terms and conditions.
- Checks particular treatment plan is necessary for the patient.
- Refers for a second opinion for cases where there is doubt in treatment plan.
- Maintains daily productivity targets and service levels.
- Manages routine daily claims administration work.
- Coordinates work flow & meet deadlines.
**Behavioral Requirements**
- Strong verbal and written communication skills.
- Show flexibility, excellent interpersonal skills.
- Team Player.
- Attention to detail and quality.
- Ability to work well with all levels of internal management and staff, as well as outside clients and users.
- Ability to train other staff.
- The ability to communicate sensitively and effectively with claims department and other departments having regard for the strict need for confidentiality.
- Experience of working with senior managers and understanding the necessity to act in a pleasant and courteous manner and to be able to work effectively with others.
- The ability to exercise initiatives and be able to work flexibly under pressure and to tight deadlines.
**Behavioral Competency**
**Customer & Market Excellence**:
- Strive for excellence at every touch point with the customer
- Foster state-of-art technical/operational knowledge and strive for continuous simplification
- Be the benchmark
**Collaborative Leadership**:
- Empower the team and provide purpose and direction
- Develop people, provide feedback and care to employee wellbeing
- Collaborate and exchange best practice.
**Entrepreneurship**:
- Act on opportunities, anticipate trends, take risk, and promote a culture that allows for honest failure
- Take ownership and responsibility
- Embrace innovation and a culture that allows to make decisions without fear of retribution.
**Trust**:
- Act with integrity, honor commitments, tell the truth
- Foster diversity and inclusiveness
Act transparently and promote corporate social responsibility.
**Minimum Requirements**
- Education: Bachelor’s of Medicine (MBBS)
- Experience: 2+ years Medical Practical Experience (reputable insurance provider, broker or a TPA experience 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
**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**:
36644
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