Claims Management Senior Processor
3 weeks ago
SUMMARY
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.
MAIN TASKS
•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. •Compares data on claims applications. •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 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. •Filing/Monitoring
•Stands as a reference person for information on inquiries concerning claims processing procedures. •Monitors correct application of beneficiary share accordingly on service items billed. •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.Other Duties
•Researches claims as needed •Obtains and audit medical records to compute and record patient charges. •Performs other related duties incidental to the work described herein BEHAVIORAL REQUIREMENTS •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. •Demonstrate commitment to produce output base results. •Knowledge of overall insurance industry practices is a plus; the ability to exercise initiatives and be able to work flexibly under pressure and to tight deadlines. •Must have the ability to communicate sensitively and effectively with claims department and other departments having regards for the strict need for confidentiality. BEHAVIORAL COMPETENCYCustomer & 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 benchmarkCollaborative 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
•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. •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.38132 | Operations | 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 shape a better future for our customers.
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.
Note: Diversity of minds is an integral part of Allianz' company culture. One means to achieve diverse teams is a regular rotation of Allianz Executive employees across functions, Allianz entities and geographies. Therefore, the company encourages its employees to be motivated in gaining varied skills from different positions and to collect experiences from across Allianz Group.
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