Medical Claims Doctor

Job Level: Professional

Location:

Jdeideh, LB

Area of Expertise: Customer Services & Claims

Unit: Allianz Partners

Employing Entity: NEXtCARE Lebanon SAL

Job Type: Full-Time

Remote Job: Hybrid working

Employment Type: Permanent

ID: 92797

Position Cluster: Non-Executive

Precertification doctor shall ensure that admissions, procedures, tests and treatments are necessary, appropriate and cost effective, ensure cost containment with respect to the best clinical practice

What you do

·Shall take the medical decision for all in-patient claims and any other type of high cost claim, severe, suspicious or complicated

·Ensure follow up and that medical treatment given by providers is necessary, appropriate and cost effective

·Follow up In-patient claims on daily basis till patient's discharge in close coordination with Precertification center staff in order to update the authorization in line with policy terms and conditions

·Ensure that admissions are medically necessary

·In charge of ongoing research relating to health, disease and therapy issues.

·Ensure cost containment with respect to the best clinical practice as per below examples and not limited to:

·Ensure that all procedures, tests and treatment are related to the motive of admission.

·Ensure that prescribed tests are necessary to be performed on in-patient basis

·Prohibit abuse in admission's indications, length of stay, tests request, surgical codes not corresponding to the operation performed

·Prohibit fraud

·Ensure that codes requested are in line with the procedure performed and as per CPT nomenclature, regulations and rules

·Ensure that length of stay is adequate as per procedure requested and patient clinical status

·Provide high quality control in coordination with the providers and treating physicians

·Case assessment by assigning the accurate code as per international classification for diseases ICD 9 with summarized medical observation

·Address the queries of Precertification center staff, payers, members, healthcare providers and medical professions with regard to medical claim coverage decision within the guidelines of NEXtCARE’s policies and procedures

·Responsible and accountable for the confidential, proper administration of insured member data as well as system, policy and medical information

·To perform special assignments as directed by Direct Manager

·Keep Direct Manager aware of issues/concerns including complaints and delay

·Responsible for utilizing medical knowledge base, effectively collaborating and promoting collegial relations to enhance the quality and cost-effectiveness of healthcare for insured member

·Assist in bills audit including reimbursement claims

·Attend trainings as required.

Internal Business Processes

·Active involvement in the implementation and continuous improvement of TAT.

·Develops and recommends improvements of facilities, equipment, or procedures to improve safety, quality, and efficiency

•AI READINESS Work effectively in an environment shaped by artificial intelligence (AI), machine learning, data, analytics and cloud-based tools, using insights responsibly with our standards of data governance, security and ethical use.

What you bring

•Education: Bachelors Degree in Medicine Required

•Experience: 2+ Years of experience in TPA or Hospitals or in a similar role

•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

How we hire
Agency Statement Allianz Partners does not accept unsolicited CV’s or approaches from agencies. We only work with partners on our approved supplier list, under contract. Any unsolicited submission will not be considered

Key benefits/What we offer

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.

At Allianz Partners, Artificial Intelligence (AI) is transforming service delivery and innovation. By leveraging Business Intelligence and Data Analytics, we enhance strategic decision-making and customer experiences. Our commitment to Ethical AI ensures responsible deployment, maintaining data integrity and trust. Conversational AI improves communication, while Emerging Technologies and Generative AI drive industry leadership and new opportunities. With robust Information Security Management, we protect sensitive information, ensuring compliance and security. Embrace the future of AI with Allianz Partners, where possibilities become realities.

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 to shape a better future for our customers and 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. And the foundation for this is our inclusive workplace, where people and performance both matter, and nurtures a culture grounded in integrity, fairness, inclusion and trust.

We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristics protected under applicable local laws and regulations.

Great to have you on board. Let's care for tomorrow.

Note: Having different strengths, experiences, perspectives and approaches is an integral part of Allianz‘ company culture. One means to achieve this is a regular rotation of Allianz Executive employees across functions, Allianz entities and geographies. Therefore, the company expects from its employees a general openness and a high motivation to regularly change positions and collect experiences across Allianz Group.