Senior Claims Reconciliation Medical officer

at  Allianz Partners

JOB OVERVIEW

The Senior Claims Reconciliation Medical Officer - will assess from a medical perspective the Provider claims and compare their usual reasonable customary standards versus medical practices and market law.

KEY REQUIREMENTS / WHAT YOU BRING

• Bachelor’s of Medicine (MBBS).
• Medical Practical Experience (reputable insurance provider, broker or a TPA experience 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

• Manages routine daily claims adjudication work.
• Coordinates work flow & meet deadlines.
• Evaluates claims with regards to eligibility and medical standards
• Takes decisions on high cost and complicated cases based on standard operating procedures.
• Investigate disputed rejected claims and respond with the appropriate justification
• Attends calls and e-mails from insurance companies, clients, and providers.
• Analyze reconciliation files and create summary with recommendation and action to reduce conflicting decisions with the Providers
• Increases efficiency, minimizes errors and administration time.