Specialist Claim Hospital Fax (Claim Assessor)

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Specialist Claim Hospital Fax (Claim Assessor)

Insurance

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.

Key Responsibilities

1. Hospital Fax Claims

• • 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, by covering the below actions:
  • Approve for the payment base on authorization
  • Perform rejection of fax claims received Require the additional information Issue memo into the system for administration in performing next steps
  • Submit for further investigation
  • Request the hospital records from hospital
  • Continuously monitor and make decision for the pending cases of Claims Hospital Fax, or back log

1. Hospital assessment Claims (OPD cashless)

1. • Provide support team in handling the OPD cashless claims from the hospital
   • Perform investigation and make decision for OPD cashless claims received in the system
   • Approve for the payment base on authorization
   • Perform rejection of fax claims received
   • Require the additional information
   • Issue memo into the system for administration in performing next steps
   • Submit for further investigation
   • Request the hospital records from hospital
   • Continuously monitor and make decision for the pending cases of OPD cashless Claims Hospital or back log

1. Consolidate/manage the complex cases which requires for Claim Committee Decision, and present to Claim Committee and COO/ CEO according to the authorization
2. Report- Collect the information, and support Manager - Claims Hospital Fax in providing the daily and monthly reports regarding to volume and turnaround time of Claims Hospital Fax
3. Give consult / advise medical related to jr. claim assessor or others

Must Have

• Bachelor’s or master’s degree in business administration, Nursing, Business of Sciences (Medical Technology), or other related field
• At least 2 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 or data software Power BI will be advantage
• Strong leadership/supervision skills
• Any AI-future skills e.g., ChatGPT, or CoPilot365, will be advantage

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. Their needs inspire our thinking and guide our actions. Together, we can build an environment where everyone feels empowered and confident to explore, grow and shape a better future – for our customers and for 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. The foundation for this is our inclusive workplace, where people and performance both matter, and where integrity, fairness, inclusion and trust are at the heart of our culture. We therefore welcome applications regardless of ethnicity or cultural Internal background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristics protected under applicable local laws and regulations.

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