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Sr. Specialist - AAGI Partnership Sales Admin & Reporting
atAllianz Ayudhya Assurance PCL12.
Job Summary :
1). Reviews claim and medical reports (medical indication assessment) - Verify the eligibility of the claim by using and applying the medical knowledge to pre-arrangement cases.- In case of medical issues such as medical necessity for the procedures have to consult medical consultant team.- Applies all medical necessity guidelines (Thai Medical Practice Guidelines), determine coverage and apply all cost containment measures.- Sending the criteria checklist to consultant doctor and benchmark price& LOS comparison.- The conclusion and issuing the confirmation letter to the providers within SLA (3 days)- Control the cost-effectiveness of medical care and ensure that any new clinical procedures, drugs or technology are appropriate and safe for our customers.- Study and understand A policy& coverage to apply pre-arrangement and admission part.- Coordinate with Internal team such as corporate key account, care coordinator, Medical team, and External team such as utilization nurses from the hospital.
2). Collaboration process with Health Concierge, Health Solutions& Care Coordination team step as below ;- Screening the case which meets the criteria for collaboration project or package.- Sending the criteria checklist to consultant doctor.- Benchmark price& LOS comparison.- Package price checking of each provider.- Provider negotiation.
3).Detects suspicious, fraud or abuse claim by providers and refer to Clinical Governance Team. 4).Process Cooding (ICD codes) based on medical procedures and the claim process
Quaifications :
5.Any AI-future skills e.g., ChatGPT, or CoPilot 365, will be an advantage
.
Experience required
- 3 years
Salary
- Negotiable
Job function
- Product / Brand Management
- Sales
- Human Resources
Job type
- Full-time
Company overview
When people talk about INSURANCE they talk about Allianz Ayudhya COME JOIN US! As Thailand's largest public life insurance joint venture company Allianz Ayudhaya, we are committed to providing people with financial services and products that best service their needs. With over 60 years of exp ...
Why join us: Allianz Ayudhya Assurance Pcl. is committed to creating work opportunities and building a high performance culture that not only upholds the company’s core policies but also develops each and every employee’s capabilities. We have acquired a wide range of compensations and benefits fo ...
Benefits
- Dental Insurance
- Employee discount
- Five-day work week
- Flexible working hours
- Health Insurance
- Social Security
- Life Insurance
- Gym membership