Role Purpose
To be fully trained and aware of claims handling process including
adjudication & fraud, waste and abuse management. Moreover, ensuring that
daily assigned tasks are completed withing the specified time frame in line
with Bupa's values.
Key Accountabilities
* Process all the daily batches of claims assigned in line with medical policy and Out-patient adjudication guidelines while using his/her medical background in conjunction with the instructed guidelines.
* Assures that each OP claim has been processed as per the checklist of steps involving checking of physical claim (or scanned image on the document management system), and cross checking with the electronic claims data on Edge, and reflecting the right decision for every claim on the operations system.
* Achieve daily target in terms number of claims processed.
* To achieve required quality through achieving at least 95% accuracy level on monthly quality audits, in order to maintain the quality standard set for the job.
* Makes sound medical decisions that minimize the opportunity to be challenged by providers, and consults with the medical manager where in doubt.
* Reports abnormal trends of provider practice for adjudicated claims where needed.
* Detects and escalates FWA cases to the concerned teams in line with Claims handling guidelines.
Bachelor's degree in pharmacy
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…
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…
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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