Job Description
Analyze data to assess the accuracy of claims payments.
Review plan documents, service agreements, and provider contracts.
Perform site visits at Third-Party Administrators to review claim information.
Communicate audit results in a structured report format within required
timelines.
Identify non-routine audit procedures that should be performed.
Communicate with clients and other parties involved in claims processing, such
as insurance agents, or medical providers.
Review information provided by clients regarding the nature of their claim and
other pertinent facts.
Analyze documentation to determine whether claims are valid based on industry
standards and regulations.
Review policies and procedures to determine if they are being followed
correctly and fairly.
Determine whether settlement offers made by insurance companies are adequate.
Review medical records for accuracy and completeness.
Review insurance policy provisions, coverage limits, and exclusions to
determine if coverage exists for specific claims.
Conduct investigations to determine the validity of claims.
Review insurance claims, identifying errors, and making recommendations for
changes.
Job Requirements
Bachelor’s degree (Medical) preferably Dental from a reputed University.
At least 1 years’ experience working with medical claims data along with
auditing expertise, preferably in hospitals / Insurance companies.
Familiarity with medical terminology.
Strong interpersonal and organizational skills.
Excellent analytical and problem-solving skills.
Proficiency with MS Office products.
Excellent verbal and written communication skills.
https://careers.alseef-hospital.com/jobs?country=615c8be2d72abe00261a3c0a
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 busines…
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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 busines…
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 busines…
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 busines…
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 busines…
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 busines…
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