Medical Provider Performance Executive

3 weeks ago

dubai, United Arab Emirates Allianz Popular SL. Full time
Allianz Partners is the home for those who dare – a supportive place where you can take the initiative to grow and to actively strengthen our global leadership position. By truly caring about people – both its and corporate customers and its 21,112 employees – Allianz Partners fosters a culture where its employees are empowered to collaborate, perform, push the boundaries and challenge the industry.What you would doThe Medical Provider Performance – Executive is responsible for conducting objective, fair, thorough, unbiased and timely investigations of healthcare providers’ performance whist monitoring best of relationships with all parties.Key responsiblities but not limited to;• Provider Performance Monitoring of Medical providers for allocated regions/countries.• Generating saving and recoveries through Provider Performance Monitoring protection and prevention.• Prevent leakages from overutilization by regular monitoring of provider performance.• Data mining and data analysis are required for conducting investigations on provider claims. • Support and drive the savings target strategy as set by the Global Head of MPM.• Support the strategy and processes as outline by the Medical Provider Performance Manager.• Manage onsite campaigns, in-house claims audit and mystery shopping campaigns• Anticipate and escalate matters timely to the manager.• Review files, gather information, collect evidence to detect any aberrant patterns that lead to deviations from the benchmarks.• Assesses the scope and determine the methodology needed to carry out an efficient investigation. • Prepare comprehensive investigative reports and analysis• Document all evidence obtained in the investigation in order to substantiate meritorious claims, to deny unjustified claims, to recover inappropriate payments or to recommend action against responsible parties. • Collaborates and communicates internally with associated department’s i.e. legal, compliance, finance, claims operations as well as external clients and Providers.• Consults with legal, compliance and regulatory authorities for cases that may involve legal action.• Manages and maintains provider relationship in coordination with MPM team and works within legal, compliance and regulatory framework.• Ensures investigations have a clear, single-focused intent of covering/uncovering and providing necessary facts resolve a claim.• Manages and ensures generation of periodic dashboards to evaluate and monitor claim cost, identify the utilization trends & variances to initiate the audit • Supports with the development and training of company personnel in analyzing the Provider performance monitoring.• Participates in specialized projects and assignments related to procurement, as required.• Uses judgment, diplomacy and confidentiality with respect to the complete procurement process, ensuring integrity.• Preserves the reputation of company, beneficiaries, payers and all other parties Involved. Participates in specialized projects and assignments related to procurement, as required.What you need• Bachelor’s Degree in medical or paramedical stream is a must.• Minimum 1 year Allianz Partners experience is a must.• Expertise in general health insurance industry trends and regulations. • Advanced skill in using Microsoft excel is a must.• Good analytical & audit skill in medical coding.• Requires ingenuity and creativity to obtain case information not readily available, along with the ability to work independently with minimum supervision. • Good organizational skills are needed to manage a high volume of assigned cases as well as the regular exercise of independent judgment and initiative to investigate allegations.• Must have the analytical ability necessary to review, interpret and evaluate relevant information essential in resolving sensitive and complex investigations.• Strong attention to detail.• Strong interpersonal/relationship skills• Ability to work with a wide diversity of individuals and within a team. • Excellent verbal and written communication skills.• Ability to maintain confidentiality and respect through all correspondences.• A high degree of integrity, dependability, accountability and confidentiality is required for handling information that is considered personal and confidential.• Ability to adapt to change, meet the changing demands of work environment, any delays or other unexpected demands.• Ability to treat people with respect under all circumstances, instill trust in others besides upholding the values of organization. 47905 | Underwriting | Professional | Non-Executive | Allianz Partners | Full-Time | PermanentAllianz 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.We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, disability or sexual orientation.Join us. Let's care for tomorrow.
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