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Claims Officer
2 weeks ago
We are Allianz Partners. The leader in assistance and insurance solutions in the areas of international health, assistance, automotive and travel insurance. Allianz Partners is a global family of over 19,000 employees across 78 countries. This role is in the International Health part of the business, which has a number of well-known customer facing brands such as Allianz Care, Nextcare and Medi24.
The International Health line of business provides international health, life and disability insurance and services, reinsurance and administration services to a wide range of customers. These include multinational companies, intergovernmental organisations (IGOs), non-governmental organisations (NGOs), private individuals, families and students. Our mission is to ensure that customers have access to quality healthcare through our support, care and commitment to go the extra mile. We are a truly global health partner for our customers, ensuring fast and simple access to the best advice, treatment and value for our customer
**JOB Overview**
The role of Claims Officer involves processing medical claims for clients worldwide. We ensure a high level of client service while processing claims within an industry leading 48 hours.
The Claims Officer adjudicates also Medical Providers’ Claims, making sure that services are eligible as per policy terms and conditions, are in correlation with the authorized guarantee of payment given and are paid as per the agreed tariffs with providers.
The Claims Department is a very fast paced and challenging environment, with many different languages used and a mixture of cultures.
**KEY RESPONSIBILITIES/ What you do**
Key responsibilities will include, but are not limited to, the following:
- Adjudicate and process Claims within the agreed company SLA - clear to zero, in accordance with policy benefits to facilitate the company achieving its loss ratio target
- Use Allianz Partners client database accurately and effectively to ensure reports generated give a true reflection of the department’s workload, which consequently facilitates effective target planning
- Operate within and meet the conditions of company service standards, clear to zero, to guarantee customer satisfaction and retention
- Contribute to the team and departmental productivity targets so that the agreed SLA is achieved and a high level of customer service is provided.
- In line with the company’s policy on cost containment identify duplicate payments, overbilling, up coding, possible non-disclosure and fraudulent claims
- Respond to customer enquiries accurately and professionally and if necessary, liaise with other departments for support to ensure an efficient and professional response is given thereby achieving customer satisfaction
- Participate in departmental medical training to expand knowledge of medical terminology and procedures and to develop comprehensive claims processing skills
- Assume additional tasks to effectively support the Team Leader to deliver on team KPI’s and deputise for Team Leader, as needed
- Give support and guidance on escalated issues, complaints and challenging claims and lead by example
- Ensures adaptability in various claims handling work-related tasks to be able to facilitate a multi-tasking role.
- Ensures that high quality targets (standard of work performance) are achieved at all times.
- Support your Team Leader to drive engagement within the Team
- Other Ad hoc duties as required
**KEY REQUIREMENTS / What you bring**
- 1-2 years’ experience in a customer focused environment, ideally in clinical, paramedical roles or TPA or insurance roles.
- Medium French accent is needed
- Proficiency in MS Office
- Completion or progression towards the Diploma in Private Medical Insurance.
- A highly customer-focused individual with strong interpersonal, communicative and accuracy skills.
- Team player
- Physically fit to carry out duties.
- Ability to demonstrate sounds work ethics.
- Ability to work under pressure and to meet tight deadlines and service standards.
As an equal opportunity employer, Allianz Partners recognizes that our strength lies in our people and we are committed to diversity and inclusivity. So if you would like to be part of a global company that offers international career opportunities, kick-start your career and dare to join us
**Job Level**:
- Entry Level
**Location**:
- Cairo, EG**Area of Expertise**:
- Customer Services & Claims
**Unit**:
- Allianz Partners
**Employing Entity**:
- Nextcare Egypt
**Job Type**:
- Full-Time
**Remote Job**:
- Hybrid working
**Employment Type**:
- Permanent
**ID**:
- 55561
**Position Cluster**:
