Job description / Role
Main Tasks
- Supervise the Personnel and the activities of the Claims Reconciliation Team and ensure daily productivity and quality targets are defined, monitored and reported to the Manager and Heads and with the senior leadership.
- Produce Monthly Management Reports with Reconciliation Status (Open and closed) including disputed and payable amount.
- Liaise with MPM and BD to ensure reconciliations are processed accurately and on time. (Timely Settlement and Timely submission/resubmission)
- Will directly liaise with MPM and BD to escalate Unresolved or stand-off reconciliation cases for intervention and support to close the reconciliation.
- Formulate and implement changes and required process improvements not limited to the reconciliation process only but also to the other functions where oversight and discrepancies were identified such as adjudication errors, system errors, un-clear rejection reasons, timeline and technical errors.
- Handle and support direct communication with the healthcare providers on their rejection ratio and reconciliation review findings.
- Coordinate with internal and external customers (Finance, MPM, ACE, BD, MCD, CMD, Payers) as required by the reconciliation process.
- Communicate and respond externally with Providers and Payers Accurately
- Carry out claim investigation and review and determine required responses to related queries.
- Generate required reports to facilitate the reconciliation process
- Investigate disputed rejected claims and respond with the appropriate justification
- Facilitate coaching and feedback meetings with stakeholders (external and internal) related with the reconciliation requirements
- Conduct Reconciliation meetings with the stakeholders as required by the reconciliation process.
Requirements
Main Requirements
- Bachelor's Degree; Paramedical background preferred with medical coding.
- 3 + years filing/documentation experience.
- Experience within the Health Care Industry, TPA's, insurance companies, Hospitals, Medical Centers is a plus.
- Physically fit to carry out duties .
About the Company
With over 159,000 employees from 172 nationalities across more than 70 countries, we are one of the world's most trusted insurance and asset management companies. We offer a broad range of products and services in property/casualty insurance, life/health insurance, and asset management. We have our largest operational presence in Europe, and our parent company, Allianz SE, is headquartered in Munich, Germany. From jobs in Actuarial, Business and IT to Inhouse Consulting and Investment Management - your opportunities are endless!