Claims Management Assessor
Job Level:
Professional
Location:
Dubai, AE
Area of Expertise:
Customer Services & Claims
Unit:
Allianz Partners
Employing Entity:
NEXTCARE Claims Management LLC
Job Type:
Full-Time
Remote Job:
Hybrid working
Employment Type:
Permanent
ID:
60786
Position Cluster:
Non-Executive
The Claims Management - Assessor will provide quality service to clients by promptly and effectively assessing and processing claims and approval according to operations set standards for direct type of claims.
What you do
•Evaluates claims with regards to eligibility and medical necessity if required.
•Ensures that insurance claims information is entered into the system correctly, to ensure accurate processing and timely payment.
•Can Perform Direct Claims Documents handling tasks including claims tracking, payment order generation and releasing.
•Ensures that provider’s fees and service items charges coincide with their existing contract price list with Nextcare.
•Ensures the accuracy of the entered data as per the existing standard steps and procedures of direct claims processing.
•Compares data on claims applications.
•Screens claim documents and process claim adjustment including performing medical and technical review of claims under reconciliation.
•Ensures Payment Orders are properly created and forwarded accordingly for final documentation and filing.
•Ensures adaptability in various claims handling work-related tasks (e.g. claims reconciliation review, claim correction, etc.) to be able to facilitate a multi-tasking role.
•Ensures that high quality standard of work performance is achieved at all times
•Stands as a reference person for information on inquiries concerning claims processing procedures.
•Monitors correct application of beneficiary share accordingly on service items billed.
•Makes sure that claims are properly audited of all data entered with accurate medical claims details.
•Notes all discrepancies during the course of the system process are properly forwarded and notified to immediate supervisors and concern units.
•Provide requisition of office supplies for Individual and Team requirement.
What you bring
•Bachelor’s degree ( Nursing ), with at least 2 years of clinical experience background preferred.
•3+ years filing/documentation experience. Experience within the Health Care Industry, TPA’s, insurance companies, Hospitals, Medical Centers is a plus.
•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.
•Attention to detail and ability of multi-task.
•Organizational & time management skills.
•Excellent team player.
•Ability to meet tight deadlines.
•Ability to work under pressure to tight deadlines.
•Strong communication skills.
•Ability to work well with all levels of internal management and staff, as well as outside clients and users.
•Ability to demonstrate sounds work ethics.
•Show flexibility with excellent interpersonal skills.
•Flexible to work in shifting schedule.
•Demonstrate commitment to produce output base results.
•Knowledge of overall insurance industry practices is a plus; the ability to exercise initiatives and be able to work flexibly under pressure and to tight deadlines.
•Must have the ability to communicate sensitively and effectively with claims department and other departments having regards for the strict need for confidentiality.
What we offer
Our employees play an integral part of our success as a business. We appreciate that each of our employees are unique and have unique needs, ambitions and we enjoy being part of their journey. We are there to empower you and your professional and personal goals and for that reason here are some of our benefits:
- Dynamic and Multinational working environment
- Trainings and programs dedicated to Learning and Development (e.g. free access to LinkedIn Learning)
- A wide range of employee benefits such as performance bonus, health insurance.
- Modern Offices
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60786 | Customer Services & Claims | Professional | Non-Executive | Allianz Partners | Full-Time | Permanent
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