Job Responsibilities:
* Conduct a robust and comprehensive auditing function for all health claims assessed by external claims management companies.
* Monitor and analyses s of health claims data ensuring alignment with base utilization assumptions and market medical services costs.
* Compile and prepare regular MIS reports regarding utilization and Medical provider costs and communicate with clients with high L/R
* Suggest enhancement business procedures ensuring maximum efficiency of processes.
* Reimbursement process handling from submitting claims until delivering payment with regular reports on TAT and transfer ratio
* Develop and implement process for detecting Fraud cases.
* Handling complaints within agreed SLA and reporting them on daily basis
Job Qualifications:
* Medical Degree
* Post graduate degree is a plus
If you are interested in the above mentioned vacancy, please apply now, with
your resume attached
Note: Please do not change the automatically generated e-mail subject or
your application will be discarded.
Company Profile: Every Day, Around the World, People Reach for Unilever Products. Our Brands Are Trusted Everywhere And, By Listening to The People Who Buy Them, We've Grown into One of The World's Most Successful Consumer Goods Companies. In Fact, 150 Million Times A Day, Someone Somewhere Chooses…
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** **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 Accountabil…
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…
**Summary:** The Case Management Utilization Review Officer is responsible for in managing the High cost cases while ensuring that departmental goals, timeline of activities, and compliance measures are met. **Main Tasks:** * Performing complete file review of high cost claims with regar…