Specialist - Claims Payment (direct health claim)

Job Summary

The position is responsible for managing end-to-end claims processing, including registering claims, verifying documentation, assessing policy coverage, and approving claim payments within assigned authority. The role requires direct hands-on experience in claims assessment and payment, ensuring accuracy, compliance, and a high standard of customer service throughout the claims journey.

Key Responsibilities

• Register and open claim cases received from members and healthcare providers
• Verify completeness and accuracy of claim documentation in accordance with company standards
• Assess policy coverage, benefit entitlements, and claim eligibility based on policy terms and conditions
• Approve claim payments within delegated authority limits using professional judgment and experience
• Coordinate with internal stakeholders (e.g., Underwriting, Provider Network) and external parties (hospitals, service providers) to obtain required information
• Ensure all claim records and processing activities are accurately captured in the Claims Management System in a timely manner
• Communicate claim status updates clearly and professionally to customers and providers
• Support quality assurance activities and contribute to continuous improvement initiatives within claims operations
• Perform other duties as assigned

Qualifications

• Bachelor’s degree in public health, Medical Technology, or related fields
• Background in the insurance industry is preferred

• Minimum 2 years of direct experience in claims registration, assessment, or related claims functions
• Proven capability to handle claims processing independently and accurately within defined authority limits

Key Competencies

• Strong technical knowledge of claims processes, policy coverage, and benefits
• High attention to detail with strong analytical and problem-solving skills
• Effective communication and stakeholder management abilities
• Ability to work efficiently in a fast-paced operational environment
• Commitment to delivering excellent customer experience
• Any AI-future skills e.g., ChatGPT, or CoPilot365, will be advantage

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. We are united by a shared commitment: to put our customers first and at the centre of everything we do. Their needs inspire our thinking and guide our actions. Together, we can build an environment where everyone feels empowered and confident to explore, grow and shape a better future – for our customers and for the world around us. At Allianz, we stand for unity: we believe that a united world is a more prosperous world, and we are dedicated to consistently advocating for equal opportunities for all. The foundation for this is our inclusive workplace, where people and performance both matter, and where integrity, fairness, inclusion and trust are at the heart of our culture. We therefore welcome applications regardless of ethnicity or cultural Internal background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristics protected under applicable local laws and regulations.

Join us. Let's care for tomorrow.