Claims Processing Officer
Cairo, EG
The Claims Processing Officer evaluates and audits providers’ bills and processes them on the system. He / She performs scan for detection of missing documents and ensures that medical report, prescription /tests /invoices are coherent.
What you do
- Audit and process all kinds of providers’ bills.
- Screen claim documents
- Ensure that proper pricing is applied for bills before processing them in TATSH.
- Process claim adjustment.
- Apply AI-based screening techniques to ensure that insurance claims information is entered into the system correctly, to ensure accurate processing and timely delivery to payers.
- In charge of checking all required fields on TATSH to ensure accurate processing such as visa notes, precertification centre notes, contract notes, policy file, medical file, faxes, etc.
- In charge of processing and recording details of the invoice on TATSH in accordance with policy terms and conditions, product, TOB, and other information as relayed by the medical auditor and provider and/or the other relevant details as gathered by the Precertification officer.
- Daily follow up on pending claims/issues with concerned departments until problem resolution.
- Inform Network department when receiving a jumbo claim as per agreed procedure in order to obtain a special discount from providers.
- In charge of reporting in writing to the Network department regarding any deviation from the provider concerning the application of the agreed tariff
- In charge of reporting in writing to the Team Leader/Manager regarding complaints received by the Claims Processing department and relating to payers/providers invoices
- In charge of reporting in writing to the Team Leader/Manager regarding any information/task required from other departments
- Follow and apply the internal procedures of the Department
- Responsible and accountable for the confidential, proper administration of insured member data as well as system, policy and medical information
- Any other duties as requested by the Direct Manager
What you bring
- Education: Pharmacy Degree
- Experience: 2+ years experience within the Health Care Industry (TPA’s, Insurance companies, Hospitals, Medical Centers)
- Demonstrate commitment to producing output base results
- Ability to respect deadlines
- Excellent team player.
- Excellent communication and organizing skills
- Flexible and ability to work shift
- Willing to work overtime when requested.
- Basic knowledge of MS Office applications
What we offer
Our employees play an integral part in our success as a business. We appreciate that each of our employees is unique and has unique needs and ambitions, and we enjoy being a part of their journey. We are there to empower and encourage you with your personal and professional development ensuring that you take control by offering a large variety of courses and targeted development programs. All that in a global environment where international mobility and career progression are encouraged. Caring for your health and wellbeing is a key priority for us. This is why we build Work Well programs to providing you with peace of mind and give the flexibility in planning and arranging for a better work-life balance.
Allianz Partners is a world leader in B2B2C insurance and assistance, offering global solutions that span international health and life, travel insurance, automotive and assistance. Customer driven, our innovative experts are redefining insurance services by delivering future-ready, high-tech high-touch products and solutions that go beyond traditional insurance.
Our products are embedded seamlessly into our partners’ businesses or sold directly to customers and are available through four commercial brands: Allianz Assistance, Allianz Automotive, Allianz Travel and Allianz Care. Present in 75 countries, our 21,100 employees speak 70 languages, handle over 71 million cases each year, and are motivated to go the extra mile to offer peace of mind to our customers around the world.
We at Allianz believe in a strong inclusive culture that encourages people to speak their minds, get involved and question the status quo. We are proud to be an equal opportunity employer and 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 race, ethnicity or cultural background, age, gender, nationality, religion, social class, disability, sexual orientation, or any other characteristics protected under applicable local laws and regulations.
Great to have you on board. Let's care for tomorrow.
