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Experience:

5 years required

Job type:

Full-time

• Review Retail or Package Product claims cases to determine validity and verification of coverage within own assigned authority; identify the need for further investigation and subsequent settle claims by acceptance or denial payment in accordance to claims processing guidelines contract provision to ensure accuracy of claims settlement.
• Prepare over authority claims cases to superior for review and approval.
• Review pending cases and contact the medical providers and concerned parties to obta ...
• Control and monitor the reinsurance process to ensure the accuracy, completeness and timeliness.
• Control and monitor Salvage Sale Process in order to maximize the most benefit and transparence process.
• Work on paperless to ensure efficiency and completeness of claim process according to the company's policy and targets.
• Acquire and improve own knowledge and skills from both internal and external sources to ensure your own work's quality and continuous improvement.
• Must Have QualificationsBachelor's in Nursing.
• At least 5 years of experience in Claims Assessor.

Experience:

3 years required

Job type:

Full-time

• Provide supports to team in handling the fax claims from the hospital.
• Check the information from fax claims documents, and record into 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 Claims Hospital Fax, or back log.
• Support other teams in Claims Department when needed such as;Medical Training.
• Claim Assessment (Reimbursement and Provider Claims).
• Medical history Review.
• Must have QualificationsBachelor's Degree of Nursing, Business of Sciences (Medical Technology), or other related field.
• At least 3-5 years experience in Nursing.
• At least 2 years experience in Claims function.
• Allianz Ayudhya