acc specialist

claims administrator

claims processing officer

claims processing team leader Jobs in Manama

claims processing team leader

claims queries officer

claims analyst

Nextcare

<div>
 
 
 Key Responsibilities
 
 /What You Do
 
 
 
 <ul>
 <li>
 Represent the Global Claims Risk Unit as a Fraud Management Subject Matter Expert(SME) for cross functional activities, Client Updates, New Business Solutions and Auditing
 </li>
 <li>
 Analyze claims data to identify unusual patterns and potential fraud indicators.
 </li>
 <li>
 Support the Fraud Analysts throughout the Fraud Process (Identification, Investigation, Corrective Actions)
 </li>
 <li>
 Conduct thorough investigations into suspicious claims, including interviewing claimants and gathering relevant documentation.
 </li>
 <li>
 Utilize advanced analytics and fraud detection tools to enhance fraud detection capabilities.
 </li>
 <li>
 Perform detailed data analysis to uncover trends and anomalies indicative of fraudulent activities.
 </li>
 <li>
 Prepare comprehensive reports on findings, including actionable recommendations.
 </li>
 <li>
 Participate in cross-functional teams to develop and implement fraud prevention strategies.
 </li>
 <li>
 Ensure all fraud detection and investigation activities comply with internal policies, external regulations, and industry standards.
 </li>
 <li>
 Maintain accurate and detailed records of investigations and outcomes.
 </li>
 <li>
 Prepare and present fraud reports to senior management and stakeholders.
 </li>
 <li>
 Identify opportunities to enhance fraud detection and prevention processes.
 </li>
 <li>
 Stay current with industry trends, emerging threats, and new technologies in fraud prevention.
 </li>
 <li>
 Provide training and guidance to junior fraud analysts and other staff on fraud detection techniques and best practices.
 </li>
 <li>
 Mentor team members, fostering a culture of vigilance and proactive fraud prevention.
 </li>
 <li>
 Take part in other projects when required, review documentation and contribute where applicable, research information relating to your area and provide feedback.
 </li>
 <li>
 Other Ad hoc duties as required
 
 
 </li>
 </ul>
 
 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
 
 
 
 Key Requirements/What You Bring
 
 
 
 <ul>
 <li>
 Bachelor&rsquo;s degree in any Medical field, Finance, Business Administration, Insurance, or a related field preferred.
 </li>
 <li>
 At least 5 years&rsquo; experience in analysing and assessing medical claims of high values and complexities
 </li>
 <li>
 With proven track record in Fraud mitigation
 </li>
 <li>
 Strong ability to communicate effectively with various audiences and all levels of the organisation
 </li>
 <li>
 Proficiency in MS Office (in particular in Excel, Power BI, PowerPoint)
 </li>
 <li>
 Excellent level of written and verbal English is essential.
 </li>
 <li>
 High level of solution orientation &amp; decision making
 </li>
 <li>
 Have obtained or be working towards 1 or more of the following:
 </li>
 <li>
 Fraud (eg ACFE
 </li>
 <li>
 Medical Qualification
 </li>
 <li>
 Data Analytics
 </li>
 <li>
 International Medical Coding
 </li>
 <li>
 Legally permitted to work in the country of operations.
 </li>
 <li>
 Hybrid working option available as per business requirements.
 
 
 </li>
 </ul>
 
 How we hire
 
 Allianz Partners does not accept unsolicited CV&rsquo;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&rsquo; 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.
 
 
 At Allianz Partners, AI is revolutionizing customer service and claims management through innovative solutions. These AI-driven tools enhance productivity by streamlining complex claims processes, reducing administrative burdens, and accelerating resolution times. Our AI-powered technology has made claims processing faster, offering quicker resolutions. All while ensuring human oversight for claims to maintain service integrity. By embracing AI and Emerging Technologies, Allianz Partners continues to lead the industry, meeting ever-changing customer needs with innovative solutions. Our commitment to Ethical AI practices safeguards data integrity and trust, ensuring responsible deployment across all operations. This approach not only enhances customer experiences but also supports strategic initiatives like fraud detection and personalized product offerings, solidifying Allianz Partners' position as a leader in the insurance sector.
 
 
 Great to have you on board. Let's care for tomorrow.
</div>

Senior Fraud Analyst

<div>
 
 
 Key Responsibilities
 
 /What You Do
 
 
 
 <ul>
 <li>
 Review and analyze claims to ensure they are accurate and complete.
 </li>
 <li>
 Process claims adjustments and corrections as necessary.
 </li>
 <li>
 Reconcile claims data with financial records and systems.
 </li>
 <li>
 Identify and investigate discrepancies in claims transactions and ensure timely and accurate reconciliation of claims.
 </li>
 <li>
 Analyze claims data to identify trends and patterns.
 </li>
 <li>
 Prepare reports and presentations on claims performance and reconciliation outcomes.
 </li>
 <li>
 Utilize data analytics tools to improve the efficiency of the claims reconciliation process.
 </li>
 <li>
 Assist in internal and external audits related to claims and reconciliation.
 </li>
 <li>
 Maintain accurate and organized documentation for audit purposes.
 </li>
 <li>
 Work closely with the finance, processors, and customer service departments to resolve claims issues.
 </li>
 <li>
 Communicate effectively with stakeholders to address and resolve claims discrepancies.
 </li>
 <li>
 Handle and support direct communication with the healthcare providers on their rejection ratio and reconciliation review findings.
 </li>
 <li>
 Conduct Reconciliation meetings with the stakeholders as required by the reconciliation process.
 </li>
 <li>
 Other Ad hoc duties as required
 
 
 </li>
 </ul>
 
 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
 
 
 
 Key Requirements/What You Bring
 
 
 
 <ul>
 <li>
 Bachelor&rsquo;s degree in any Medical field, Finance, Business Administration, Insurance, or a related field preferred.
 </li>
 <li>
 Minimum of 2-3 years of experience in claims reconciliation, financial analysis, or a similar role.
 </li>
 <li>
 Experience in the insurance or healthcare industry is preferred.
 </li>
 <li>
 Strong analytical and problem-solving skills.
 </li>
 <li>
 Proficiency in Microsoft Excel and other data analysis tools.
 </li>
 <li>
 Excellent attention to detail and accuracy.
 </li>
 <li>
 Strong organizational and time management skills.
 </li>
 <li>
 Ability to work independently and as part of a team.
 </li>
 <li>
 Excellent written and verbal communication skills.
 </li>
 <li>
 Familiarity with claims processing systems and software.
 </li>
 <li>
 Understanding of regulatory requirements related to claims and reconciliation.
 </li>
 <li>
 Knowledge of accounting principles and practices.
 </li>
 <li>
 Legally permitted to work in the country of operations.
 </li>
 <li>
 Hybrid working option available as per business requirements.
 
 
 </li>
 </ul>
 
 How we hire
 
 Allianz Partners does not accept unsolicited CV&rsquo;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&rsquo; 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.
 
 
 At Allianz Partners, AI is revolutionizing customer service and claims management through innovative solutions. These AI-driven tools enhance productivity by streamlining complex claims processes, reducing administrative burdens, and accelerating resolution times. Our AI-powered technology has made claims processing faster, offering quicker resolutions. All while ensuring human oversight for claims to maintain service integrity. By embracing AI and Emerging Technologies, Allianz Partners continues to lead the industry, meeting ever-changing customer needs with innovative solutions. Our commitment to Ethical AI practices safeguards data integrity and trust, ensuring responsible deployment across all operations. This approach not only enhances customer experiences but also supports strategic initiatives like fraud detection and personalized product offerings, solidifying Allianz Partners' position as a leader in the insurance sector.
 
 
 Great to have you on board. Let's care for tomorrow.
</div>

Claims Reconciliation Officer

<div>
 
 
 Key Responsibilities
 
 /What You Do
 
 
 
 <ul>
 <li>
 Consistently checks, tracks and filing of all claims received.
 </li>
 <li>
 Data entry into company database
 </li>
 <li>
 Validating all received &amp; scanned claims against actualised volumes
 </li>
 <li>
 Perform analytical review of documentation received
 </li>
 <li>
 Ensures that there is a proper documentation, feedback, and endorsement to the concerned unit/department.
 </li>
 <li>
 Timely and precise recording of received claims.
 </li>
 <li>
 Supporting administrative function.
 </li>
 <li>
 Other Ad hoc duties as required.
 
 
 </li>
 </ul>
 
 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
 
 
 
 Key Requirements/What You Bring
 
 
 
 <ul>
 <li>
 High school diploma or equivalent; Bachelor&rsquo;s degree is advantage
 </li>
 <li>
 1-2 years&rsquo; experience in a customer focused environment, ideally in clinical, paramedical roles or TPA or insurance roles.
 </li>
 <li>
 Proficiency in MS Office
 </li>
 <li>
 A highly customer-focused individual with strong interpersonal, communicative and accuracy skills.
 </li>
 <li>
 Data entry experience would be helpful as it is quite important to be successful for the role
 </li>
 <li>
 Demonstrates excellent attention to detail, accuracy, and the ability to meet strict deadlines
 </li>
 <li>
 Ability to multitask, prioritize and work independently or within a team environment.
 </li>
 <li>
 Organizational skills
 </li>
 <li>
 Team player
 </li>
 <li>
 Physically fit to carry out duties.
 </li>
 <li>
 Ability to demonstrate sounds work ethics.
 </li>
 <li>
 Ability to work under pressure and manage time effectively
 </li>
 <li>
 Legally permitted to work in the country of operations.
 
 
 </li>
 </ul>
 
 How we hire
 
 Allianz Partners does not accept unsolicited CV&rsquo;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&rsquo; 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.
 
 
 At Allianz Partners, AI is revolutionizing customer service and claims management through innovative solutions. These AI-driven tools enhance productivity by streamlining complex claims processes, reducing administrative burdens, and accelerating resolution times. Our AI-powered technology has made claims processing faster, offering quicker resolutions. All while ensuring human oversight for claims to maintain service integrity. By embracing AI and Emerging Technologies, Allianz Partners continues to lead the industry, meeting ever-changing customer needs with innovative solutions. Our commitment to Ethical AI practices safeguards data integrity and trust, ensuring responsible deployment across all operations. This approach not only enhances customer experiences but also supports strategic initiatives like fraud detection and personalized product offerings, solidifying Allianz Partners' position as a leader in the insurance sector.
 
 
 Great to have you on board. Let's care for tomorrow.
</div>

Claims Administrator

<div>
 
 
 Key Responsibilities
 
 /What You Do
 
 
 
 <ul>
 <li>
 Operate within and meet the conditions of company service standards, clear to zero, to guarantee customer satisfaction and retention.
 </li>
 <li>
 Review and handle claims according to the established standard procedure.
 </li>
 <li>
 Support the team and departmental productivity goals to meet the agreed upon Service Level Agreement (SLA) and deliver exceptional customer service
 </li>
 <li>
 Provide accurate and professional responses to client inquiries, and if needed, collaborate with other departments to ensure prompt and efficient resolution.
 </li>
 <li>
 Engage in departmental medical training to broaden understanding of medical terminology and procedures, and enhance proficiency in claims processing skills.
 </li>
 <li>
 Ensures adaptability in various claims handling work-related tasks to be able to facilitate a multi-tasking role.
 </li>
 <li>
 Ensures that high quality targets (standard of work performance) are achieved at all times.
 </li>
 <li>
 Support the Team Leader to drive engagement within the Team
 </li>
 <li>
 Other Ad hoc duties as required
 
 
 </li>
 </ul>
 
 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
 
 
 
 Key Requirements/What You Bring
 
 
 
 <ul>
 <li>
 Bachelor&rsquo;s degree in any Medical field, Paramedical, Finance, Business Administration, Insurance, or a related field preferred.
 </li>
 <li>
 1-2 years&rsquo; experience in a customer focused environment, ideally in clinical, paramedical roles or TPA or insurance roles.
 </li>
 <li>
 Proficiency in MS Office
 </li>
 <li>
 A highly customer-focused individual with strong interpersonal, communicative and accuracy skills.
 </li>
 <li>
 Team player
 </li>
 <li>
 Physically fit to carry out duties.
 </li>
 <li>
 Ability to demonstrate sounds work ethics.
 </li>
 <li>
 Ability to work under pressure and to meet tight deadlines and service standards
 </li>
 <li>
 Legally permitted to work in the country of operations.
 </li>
 <li>
 Hybrid working option available as per business requirements.
 
 
 </li>
 </ul>
 
 How we hire
 
 Allianz Partners does not accept unsolicited CV&rsquo;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&rsquo; 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.
 
 
 At Allianz Partners, AI is revolutionizing customer service and claims management through innovative solutions. These AI-driven tools enhance productivity by streamlining complex claims processes, reducing administrative burdens, and accelerating resolution times. Our AI-powered technology has made claims processing faster, offering quicker resolutions. All while ensuring human oversight for claims to maintain service integrity. By embracing AI and Emerging Technologies, Allianz Partners continues to lead the industry, meeting ever-changing customer needs with innovative solutions. Our commitment to Ethical AI practices safeguards data integrity and trust, ensuring responsible deployment across all operations. This approach not only enhances customer experiences but also supports strategic initiatives like fraud detection and personalized product offerings, solidifying Allianz Partners' position as a leader in the insurance sector.
 
 
 Great to have you on board. Let's care for tomorrow.
</div>

Claims Processing Officer

<div>
 The Case Management Utilization Review Lead is responsible for in managing the High-cost cases while ensuring that departmental goals, timeline of activities, and compliance measures are met.
 
 
 
 What You Do
 
 
 
 <ul>
 <li>
 Performing complete file review of high cost claims with regards to the multidisciplinary notes, TPR charts, physician order&rsquo;s notes, lab reports, radiology reports, drug chart sheets, consultation notes, nursing notes, progress notes, etc.
 </li>
 <li>
 Field hospital deployment or File Audit to be performed when required (Non- Physical or Physical [Provider Visit]) to capture hospital acquired infections, mismanagement, iatrogenic injuries, etc.
 </li>
 <li>
 Requesting any medical documentation or finding any missing document which is essential in decision making.
 </li>
 <li>
 Performing review of DRG Severity of Illness (SOI) in line with revision of CPT codes / ICD codes, which are being up-coded by the provider &ndash; if required discussion with the treating doctor and the medical coders.
 </li>
 <li>
 Performing utilization review for DRG cases and FFS cases with regards to and not limited to final bill review + consumables mark ups + non covered item/services + overutilization of services.
 </li>
 <li>
 Performing review of claims as per CPT and ICD coding guidelines in line with insurance regulators (DHA,DOH/HAAD,MOH).
 </li>
 <li>
 Pre-authorization and maintaining required out-put of high cost claims with detailed insight of claim on day to day basis.
 </li>
 <li>
 Adhering to the case management and cost containment protocols for elective high cost cases and medical management cases.
 </li>
 <li>
 Referring cases for second opinion when deemed necessary to confirm the best mode of management &ndash; also for cost containment to lesser Negotiating factor (NF) facilities within the member&rsquo;s network or option for home country treatment.
 </li>
 <li>
 Adjudicates High Cost claims at submission level for settlement between the insurer and health care provider as per policy terms and conditions.
 </li>
 <li>
 Adjudicates High cost claims at precertification level, authorize decision on the claim within policy terms and conditions.
 </li>
 <li>
 Continuously work to identify possible procedure inconsistencies; develop, recommend and implement improvements.
 </li>
 <li>
 Provide support to Medical Claims Officers to close all escalated claims queries within the agreed turn-around time.
 
 
 </li>
 </ul>
 Achieving a monthly savings target of AED 800,000 in line with the criteria or methodology defined by the Line Manager and Head of Department
 
 
 <ul>
 <li>
 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.
 
 
 </li>
 </ul>
 
 What You Bring
 
 
 
 <ul>
 <li>
 Bachelor&rsquo;s of Medicine (MBBS);
 </li>
 <li>
 3+ years medical practical experience (reputable insurance provider, broker or a TPA experience a plus).
 </li>
 <li>
 Knowledge of overall insurance industry practices is a plus.
 </li>
 <li>
 Legally permitted to work in the country of operations.
 </li>
 <li>
 Physically fit to carry out duties.
 </li>
 <li>
 Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.
 
 
 </li>
 </ul>
 
 How We Hire
 
 
 
 
 
 Agency Statement
 
 Allianz Partners does not accept unsolicited CV&rsquo;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&rsquo; 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&lsquo; 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.
</div>

Field doctor - Lead role

Explore 23+ Claims analyst in Manama this March. Find roles across top companies and apply now to boost your career.

23 claims analyst jobs In Manama

Senior Fraud Analyst

Claims Reconciliation Officer

Claims Reconciliation Officer

Claims Administrator

Claims Processing Officer

Claims Administrator

Field doctor - Lead role