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Medical Claims Specialist

2 months ago

Dubai, Dubai, United Arab Emirates Allianz Partners Full time
Job Summary

We are seeking a highly skilled Medical Claims Officer to join our team at Allianz Partners. As a Medical Claims Officer, you will be responsible for assessing medical approvals and policy use, ensuring that patients receive the necessary treatment.

Key Responsibilities
  • Medical Approval Assessment: Evaluate medical approvals and policy use to ensure compliance with company guidelines.
  • Treatment Plan Review: Assess whether a particular treatment plan is necessary for the patient.
  • Claims Approval: Input verbal and written claims approvals regularly, making decisions based on policy conditions.
  • High-Cost Claims: Assess high-cost claims and provide decisions on high-cost and complicated cases.
  • Client Communication: Provide clear feedback on queries from the call centre team and explain declined medical claims to clients.
  • Workflow Coordination: Coordinate workflow and meet deadlines, ensuring productivity targets are met.
  • Claims Eligibility: Evaluate claims concerning eligibility and meet daily productivity targets.
  • Adjudication: Adjudicate outpatient precertification on a first-in-first-out basis, maintaining a productivity TAT of 85% in 10 minutes and 98% within 1 hour.
  • Schedule Adherence: Adhere to schedules and punctuality, ensuring 100% adherence to schedule and punctuality.
Requirements
  • Education: Bachelor of Science degree.
  • Experience: 2+ years of medical practical experience, preferably with a reputable insurance provider, broker, or TPA.
  • Skills: Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.