Sr. Specialist - A&H Claims Investigation

About the Company

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. We are united by a shared commitment: to put our customers first and at the centre of everything we do. The foundation for this is our inclusive workplace, where integrity, fairness, inclusion and trust are at the heart of our culture.

Responsibilities

• Investigation: select locations for investigation, coordinate with administration team to request medical history from selected hospitals.
• Review medical histories and report findings to claim owners (Claim team, Pre-authorization team, Underwriting team) for further assessment.
• Administration support: provide claim consulting support to Claim, Sales and CS teams.
• Support medical training for claim team (CPU1, CPU2, ASO, Fax claim).
• Policy voidance: review and summarize medical history, propose cases to claim management for policy voidance, prepare void letters, inform membership team to refund premium, and explain void reasons to customers and related parties (if any).

Qualifications

• Degree in Nursing Science, Medical Technology (Business of Sciences) or related field.
• Minimum 5 years' experience as a Claims Assessor or in related roles within the insurance industry.
• Experience with claims workflow, systems, and prioritization & queue management.
• Strong medical knowledge.

Skills

• Ability to prioritize claim-related functions and manage queues.
• Attention to detail and accuracy control.
• Awareness of fraud/abuse in claims.
• MS Office: Word, Excel, PowerPoint, Outlook, SharePoint.
• Familiarity with AI tools (e.g., ChatGPT, Copilot365) is an advantage.

Additional Information

• Work arrangement: Onsite.
• Employment type: Full-time.