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claims administrator

claims processing officer Jobs in Digital Marketing Branding Jobs In Content Creation Social Media Management Jobs In Bahrain

claims processing officer

claims processing team leader

Nextcare

<div>
 
 
 Key Responsibilities
 
 /What You Do
 
 
 
 <ul>
 <li>
 Manages routine daily claims administration work.
 </li>
 <li>
 Coordinates work flow &amp; meet deadlines
 </li>
 <li>
 Give support and guidance on escalated issues, complaints and challenging claims and lead by example
 </li>
 <li>
 Attends calls and e-mails from insurance companies, clients and providers.
 </li>
 <li>
 Responsible for the allocation of work throughout the team, compliance with service level agreements, the quality of the service, team productivity and reducing complaints.
 </li>
 <li>
 Assist for the professional development of team members and identification of specific training needs and mentoring.
 </li>
 <li>
 Support to have successful and efficient operation of the team and the oversight of all highprofile claims.
 </li>
 <li>
 Increases efficiency, minimizes errors and administration time.
 </li>
 <li>
 Own the day-to-day escalated claims by the team, but also by customers and partners.
 </li>
 <li>
 To act as a technical reference point across the team
 </li>
 <li>
 Use Allianz Partners client database accurately and effectively to ensure reports generated give a true reflection of the department&rsquo;s workload, which consequently facilitates effective target planning
 </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>
 3-5 years&rsquo; experience in a customer focused environment, ideally in clinical, paramedical roles or TPA or insurance roles.
 </li>
 <li>
 With at least 1 year proven work experience as a team leader or similar role
 </li>
 <li>
 Organized with the ability to prioritize and multi-task
 </li>
 <li>
 Strong leadership and great analytical skills
 </li>
 <li>
 With high level of technical knowledge and professionalism at all times to lead by example
 </li>
 <li>
 Experience of working with senior managers and understanding the necessity to act in a pleasant and courteous manner and to be able to work effectively with others.
 </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 Team Leader

<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>
 
 
 Key Responsibilities
 
 /What You Do
 
 
 
 <ul>
 <li>
 Oversee the end-to-end claims reconciliation process to ensure accuracy and completeness.
 </li>
 <li>
 Identify and resolve discrepancies between claims payments and receivables.
 </li>
 <li>
 Analyze reconciliation data to identify trends, patterns, and areas for improvement.
 </li>
 <li>
 Generate and present detailed reports on reconciliation performance and discrepancies to senior management.
 </li>
 <li>
 Utilize data analysis tools and software to enhance the accuracy and efficiency of the reconciliation process.
 </li>
 <li>
 Collaborate with internal teams such as claims processing, finance, BD and MPM to ensure seamless reconciliation operations.
 </li>
 <li>
 Communicate with external stakeholders, including insurers, clients, and providers, to resolve reconciliation issues.
 </li>
 <li>
 Maintain strong relationships with all stakeholders to facilitate effective collaboration and communication.
 </li>
 <li>
 Provide leadership, guidance, and mentoring to the claims reconciliation team.
 </li>
 <li>
 Continuously evaluate and improve reconciliation processes and procedures to increase productivity and accuracy.
 </li>
 <li>
 Ensure all claims reconciliation processes comply with internal policies, external regulations, and industry standards.
 </li>
 <li>
 Provide guidance and support to junior claims reconciliation officers, fostering a collaborative and productive work environment.
 </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 3-5 years of experience in claims reconciliation, accounting, or a related field.
 </li>
 <li>
 Proven track record of successful reconciliation management and discrepancy resolution.
 </li>
 <li>
 Experience in a leadership or senior analytical role.
 </li>
 <li>
 Strong analytical and problem-solving skills with the ability to interpret complex data.
 </li>
 <li>
 Excellent communication, negotiation, and interpersonal skills.
 </li>
 <li>
 Proficiency in data analysis tools and reconciliation software.
 </li>
 <li>
 High level of accuracy and attention to detail.
 </li>
 <li>
 Ability to lead, mentor, and motivate a team.
 </li>
 <li>
 Strong organizational and project management skills.
 </li>
 <li>
 Ability to work independently and as part of a team.
 </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 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>
 Handle incoming queries from healthcare providers via phone, email, and other communication channels.
 </li>
 <li>
 Provide accurate and timely information in response to provider inquiries.
 </li>
 <li>
 Escalate complex queries to appropriate departments or senior staff members as necessary.
 </li>
 <li>
 Maintain detailed records of all queries and their resolutions.
 </li>
 <li>
 Identify areas for improvement based on query analysis and feedback.
 </li>
 <li>
 Communicate clearly and effectively with healthcare providers, ensuring a high level of satisfaction.
 </li>
 <li>
 Collaborate with internal teams to resolve issues and provide comprehensive responses to providers.
 </li>
 <li>
 Keep providers informed about updates, policy changes, and other relevant information.
 </li>
 <li>
 Participate in training and development activities to stay current with industry standards and company policies.
 </li>
 <li>
 Adherence to internal procedures and guidelines, client service agreements and compliance &amp; regulatory standards
 </li>
 <li>
 Take ownership of each query ensuring all aspects of the query are answered right first time, eliminating rework and increased customer effort
 </li>
 <li>
 Provide clear, concise and accurate responses in a professional manner, including internal and external information transfer
 </li>
 <li>
 Provide direction, next steps and clear expectations to the client where a query involves further investigation or requires further information
 </li>
 <li>
 Contribute to the team and department SLA ensuring queries are managed efficiently and effectively
 </li>
 <li>
 Exhibit a proactive approach to the clients, ensuring an ongoing focus on enhancing the customer experience through process improvements and simplification
 </li>
 <li>
 Ensure accurate recording and Categorisation of all queries in the sy
 </li>
 <li>
 Support department and colleagues to ensure overall business targets are achieved
 </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>
 With 2 years experience in a customer focused environment, ideally in clinical, paramedical roles or TPA or insurance roles.
 </li>
 <li>
 Excellent verbal and written communication skills.
 </li>
 <li>
 Strong problem-solving and analytical abilities.
 </li>
 <li>
 Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
 </li>
 <li>
 Ability to work independently and as part of a team.
 </li>
 <li>
 Strong organizational skills and attention to detail.
 </li>
 <li>
 Ability to prioritise workload and manage time effectively
 </li>
 <li>
 Experience in claims processing
 </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 Queries Officer

Alzayani Investments

Job SummaryWe are looking for a detail-oriented and assertive Warranty Supervisor to lead our claims department. In this role, you will be the bridge between our customers, our technical teams, and our manufacturers. You’ll oversee the entire lifecycle of warranty claims—ensuring they are processed accurately, submitted on time, and resolved in a way that protects our company’s bottom line while maintaining top-tier customer satisfaction.<h3> </h3><h3>Key Responsibilities</h3><ul><li>Supervise and mentor warranty administrators, providing guidance on complex claims and ensuring the team hits monthly processing targets.</li><li>Review and audit warranty claims for accuracy, technical documentation, and compliance with manufacturer policies.</li><li>Track "aged" claims and work closely with the accounting department to ensure all credits are received and reconciled.</li><li>Act as the primary point of contact for manufacturers and third-party providers regarding claim disputes and policy updates.</li><li>Identify patterns in equipment failure or claim denials and implement strategies to reduce warranty costs.</li><li>Collaborate with service technicians to ensure repair orders are documented correctly the first time to prevent "kickbacks."</li></ul><h3> </h3><h3>Qualifications</h3><ul><li>5–7 years in warranty administration, service writing, or claims management (experience in Automotive).</li><li>Proficiency with ERP/CRM software and claim submission portals.</li><li>Ability to spot trends in data and generate reports on recovery rates and department performance.</li><li>Exceptional negotiation skills—you know how to be firm with vendors but empathetic with customers.</li><li>High level of attention to detail; you’re the type of person who catches a missing serial number from a mile away.  </li></ul>

Warranty Supervisor

<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.
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Field doctor - Lead role

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