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Medical Claims Specialist
Job Responsibilities:
- Conduct a robust and comprehensive auditing function for all health claims assessed by external claims management companies (TPAs)
- Monitor and analysis of health claims data ensuring alignment with base utilization assumptions and market medical services costs.
- Compile and prepare regular reports regarding utilization and medical provider costs and communicate with clients with high L/R
- Suggest enhancement business procedures ensuring maximum efficiency of processes.
- Reimbursement process handling from submitting claims until delivering payment with regular reports on TAT and transfer ratio.
- Handling complaints within agreed SLA and reporting them on daily basis,
- Monitoring the SLAs for all services provided by The TPA and the reimbursement cycle.
Job Qualifications:
- Medical Degree.
- A post graduate degree is a plus.
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Allianz is fully committed to a workplace free of discrimination and actively promotes equal opportunities where all candidates have the same opportunity.
Allianz is committed to building a diverse workplace and recognizes that diverse employees bring varied skills, knowledge, backgrounds and perspectives to the workplace.
