Sr. Claim Hospital Fax (Claim Assessor)

About the Role

Provide supports to team in handling fax claims received from hospitals, investigates and makes decision for claims in the system. In addition, continuously monitors and makes decision for the pending cases of fax claims, or back log.

Responsibilities

• Provide supports to team in handling the fax claims from the hospital
• Check the information from fax claims documents, and record into the system
• Investigate and make decision for claims in the system, including: approve payment based on authorization; reject claims; request additional information; issue memo into the system for administration in performing next steps; submit for further investigation; request hospital records from hospital
• Continuously monitor and make decision for the pending cases of Claims Hospital Fax, or backlog
• Provide support to team in handling OPD cashless claims from the hospital and perform investigation and make decision for OPD cashless claims received in the system, including the actions listed above
• Consolidate/manage complex cases which require Claim Committee decision, and present to Claim Committee and COO/CEO according to the authorization
• Collect information and support Manager - Claims Hospital Fax in providing daily and monthly reports regarding volume and turnaround time of Claims Hospital Fax
• Give consult / advise medical related to jr. claim assessor or others

Qualifications

• Bachelor’s or master’s degree in Business Administration, Nursing, Business of Sciences (Medical Technology), or other related field
• At least 5 yrs of experience in Claims assessor, or other related fields in insurance industry
• Accuracy concern & detail orientation
• Experience in using claims/CRM systems
• Ability to prioritize claim related functions
• Knowledge of MS Office, Excel, PowerPoint; Power BI will be advantage
• Strong leadership/supervision skills
• Any AI-future skills e.g., ChatGPT, or CoPilot365, will be advantage

Additional Information

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.

Onsite. Full-time.