Role Overview
This position is hybrid working.
You will manage medical utilization and quality reviews to ensure appropriate patient care while controlling medical costs. You'll work closely with hospitals, doctors, and internal teams to review cases, improve service quality, and support our healthcare network. Focus on Utilization Review, Admission Review, and Hospital Network Management.
What You'll Do
1. Utilization Review Medical Cost Control

• Review patient admissions and length of stay to ensure medical necessity
• Conduct concurrent and on-site case reviews
• Escalate complex cases to physicians when criteria are not met
• Identify quality issues and flag them to medical leadership
• Prepare monthly reports and insights for hospital partners
• Collect only pertinent clinical information and document all UM review information using the appropriate software system

Hospital Network Medical Analysis

• Work with hospital partners to resolve inappropriate utilization
• Conduct on-site reviews and service evaluations
• Investigate and report misuse or abnormal medical practices

Medical Services Operations

• Appoint and manage panel physicians for pre-insurance checkups
• Coordinate mobile medical services and scheduling
• Manage medical room operations (staff, equipment, supplies)
• Support customer medical requests and reports
• Handle medical document issues with underwriting team
• Prepare monthly communications (e.g., medical newsletter, updates)
• Support marketing campaigns and customer programs with hospital partners
• Prepare report and payment for physician fee such as ECG, CxR, Orasure, doctor fee, Bria Lob, PRO lab and medical expense to relevant party every month
• Coordinate with underwriter by receiving the medical examination documents from underwriter such as incorrect or incomplete to review and provide feedback to physician and nurse, and provide the formal letter to physician and nurse

Additional Responsibilities

• Support projects (e.g., hospital awards, service improvements)
• Handle customer inquiries and complaints professionally

What You Need (Must-Have)

• Bachelor's degree in nursing science or related field
• At least 5 years' experience in:
• Utilization review / case management / medical cost control
• Hospital-based nursing (ICU, CCU, or medical ward)
• Strong understanding of clinical decision-making and patient care
• Experience in claim assessor roles from insurance or healthcare industry

Nice to Have

• Knowledge of utilization management tools (e.g., InterQual)
• Understanding of medical claims, ICD-10, or insurance practices
• Familiarity with healthcare analytics tools
• Good understanding of healthcare regulations
• Self-driven/management and strongly in result oriented (KPI)
• Collaborative and communication skills
• Any AI-future skills e.g., ChatGPT, or CoPilot365, will be advantage.

Why Join Us

• Work at the intersection of healthcare and insurance
• Collaborate with leading hospitals and medical professionals
• Make a real impact on patient care quality and cost management
• Grow your career in a dynamic healthcare environment

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.
Join us. Let's care for tomorrow.