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.
What you do
KEY RESPONSIBILITIES
- • 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.
• Assume additional tasks to effectively support the Team Leader in delivering on team KPIs, deputizing for the Team Leader as needed, and using AI insights to guide escalated issues, complaints, and challenging claims.
What you bring
KEY REQUIREMENTS
- 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.
- A collaborative team player who can work effectively in a team environment, using AI insights to support team goals and initiatives. .
- Ability to work under pressure and to meet tight deadlines and service standards.
What we offer
Our employees play an integral part in our success as a business. We appreciate that each of our employees is unique and has unique needs and ambitions, and we enjoy being a part of their journey.
We are there to empower and encourage you with your personal and professional development ensuring that you take control by offering a large variety of courses and targeted development programs. All that in a global environment where international mobility and career progression are encouraged. Caring for your health and wellbeing is a key priority for us. This is why we build Work Well programs to providing you with peace of mind and give the flexibility in planning and arranging for a better work-life balance.
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