Summary : The position holder is responsible to deliver excellent operational performance against planned improvement metrics and agreed KPIs and drive improvement by reviewing demand, understanding customers’ needs and, identifying and delivering process improvements.
In addition, continuously monitor and make decision for the pending cases of Claims Payment, or back log. In addition, this includes managing the complex cases and ensuring that claims reimbursement team is performed accurately according to the processes and procedures, and in timely manner.

Job responsibilities : 

'1) Claims Payment
- Lead and manage team in handling reimbursement claims.
- Provide advice, coaching and supports to team in investigating and making decision for claims assessment , by covering the below actions:
 Approve for the payment base on authorization.
 Perform rejection of claims reimbursement
 Require the additional information
• Issue memo into the system for administration in performing next steps
• Submit for further investigation
• Request the hospital records from hospital
- Continuously monitor and make decision for the pending cases of Claims Reimbursement, or back log
- Manage the complex cases which requires for Claim Committee Decision, and present to Claim Committee and COO/ CEO according to the authorization
- Ensure that claims reimbursement team  is performed accurately according to the processes and procedures, and in timely manner

'2) Support  
- Lead and manage team to support Claim reimbursement 
'3) Report
- Prepare and provide daily and monthly reports regarding to volume and turnaround time of Claims Hospital Fax and outsource fax calim
- Review and ensure that the daily and month reports are provided with accuracy and in timely manner

'4) OIC
-  Partner with Claim Relation team,
-  Lead and manage team in providing the support information to support the cases

'5) Court
- Partner with Claim Relation team,  Legal Department and lawyer in order to handle the cases which are proceeded into court
- Lead and manage team in providing the support information to support the cases
- Be a company representative to attend the court with Legal Department and lawyer

Allianz Ayudhya General Insurance