Claims Officer

JOB Overview

The role of Claims Officer involves processing medical claims for clients worldwide. We ensure a high level of client service while processing claims within an industry leading 48 hours.
The Claims Officer adjudicates also Medical Providers’ Claims, making sure that services are eligible as per policy terms and conditions, are in correlation with the authorized guarantee of payment given and are paid as per the agreed tariffs with providers.
The Claims Department is a very fast paced and challenging environment, with many different languages used and a mixture of cultures.

What you do

Key responsibilities 

•    Adjudicate and process Claims within the agreed company SLA -  clear to zero, in accordance with policy benefits to facilitate the company achieving its loss ratio target
•    Use Allianz Partners client database accurately and effectively to ensure reports generated give a true reflection of the department’s workload, which consequently facilitates effective target planning
•    Operate within and meet the conditions of company service standards, clear to zero, to guarantee customer satisfaction and retention
•    Contribute to the team and departmental productivity targets so that the agreed SLA is achieved and a high level of customer service is provided.
•    In line with the company’s policy on cost containment identify duplicate payments, overbilling, up coding, possible non-disclosure and fraudulent claims
•    Respond to customer enquiries accurately and professionally and if necessary, liaise with other departments for support to ensure an efficient and professional response is given thereby achieving customer satisfaction
•    Participate in departmental medical training to expand knowledge of medical terminology and procedures and to develop comprehensive claims processing skills
•    Assume additional tasks to effectively support the Team Leader to deliver on team KPI’s and deputise for Team Leader, as needed
•    Give support and guidance on escalated issues, complaints and challenging claims and lead by example
•    Ensures adaptability in various claims handling work-related tasks to be able to facilitate a multi-tasking role.
•    Ensures that high quality targets (standard of work performance) are achieved at all times.
•    Support your Team Leader to drive engagement within the Team 
•    Assist the in-house medical team by using AI models to streamline client hospital admissions, evacuations, repatriations, and other cases, ensuring efficient and effective service

•  can automate routine tasks, speeding up the adjudication process and ensuring claims are processed efficiently, thus helping achieve the loss ratio target

•   can enhance the use of the client database by AI analytics, providing deeper insights and generating more accurate reports, facilitating better target planning.

What you bring

KEY REQUIREMENTS:

•    1-2 years’ experience in a customer focused environment, ideally in clinical, paramedical roles or TPA or insurance roles.
•    Proficiency in MS Office
•    Completion or progression towards the Diploma in Private Medical Insurance.
•    A highly customer-focused individual with strong interpersonal, communicative and accuracy skills.
•    Team player
•    Physically fit to carry out duties.
•    Ability to demonstrate sounds work ethics. 
•    Ability to work under pressure and to meet tight deadlines and service standards.