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Medical Claims Examiner

2 months ago

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

We are seeking a highly skilled Medical Claims Examiner to join our team at Allianz Partners. As a Medical Claims Examiner, you will be responsible for assessing medical claims and making decisions based on policy conditions.

Key Responsibilities
  • Claims Assessment: Evaluate medical claims to determine their validity and make decisions based on policy conditions.
  • Treatment Plan Review: Review treatment plans to ensure they are necessary for the patient and align with policy requirements.
  • Claims Approval: Approve or deny claims based on policy conditions and medical necessity.
  • High-Cost Claims: Assess high-cost claims and make decisions on complicated cases.
  • Client Communication: Provide clear feedback to clients on claims decisions and communicate policy requirements.
  • Workflow Coordination: Coordinate workflow to meet deadlines and ensure efficient claims processing.
  • Eligibility Evaluation: Evaluate claims for eligibility and ensure compliance with policy requirements.
Requirements
  • Education: Bachelor of Medicine, Pharmacy, or Dentistry.
  • Experience: 2+ years of medical practical experience in a reputable insurance provider, broker, or TPA.
  • Work Permit: Legally permitted to work in the country of operations.
  • Technical Skills: Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.
  • Communication Skills: Strong verbal and written communication skills.
  • Interpersonal Skills: Show flexibility and excellent interpersonal skills.