medical claims officer

Job Opportunity: Senior Claims Assessor at Allianz Partners

Role Summary:

The Senior Claims Assessor provides quality service to clients by promptly and effectively assessing and managing compensation claims in accordance with operational standards. The Senior Claims Assessor is also responsible for team success through defining, implementing, and monitoring individual and team objectives, ensuring compliance with company policies and procedures.

Key Tasks:

- Evaluate compensation claims from a technical and medical perspective, according to policy terms and conditions.
- Assist Claims Assessors in handling challenging medical cases, optimizing both qualitative and quantitative output.
- Verify the necessity of a treatment plan for the patient.
- Request a second opinion for cases where there are doubts about the treatment plan.
- Provide clients with an understanding of any rejected medical compensation claims.
- Maintain daily productivity goals and service levels.
- Manage daily administrative work related to compensation claims.
- Coordinate workflow and meet deadlines.
- Provide training and on-the-job support to team members as needed.

Minimum Requirements:

- Mandatory Nursing degree.
- Practical medical experience of at least 2 years (experience with an insurer, broker, or TPA is a plus).
- Physical fitness to perform tasks.
- Legal permission to work in the country of operations.
- Fluent knowledge of MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and search skills.

Job Level:
Professional
Location:
Muscat, Oman
Specialization Area:
Customer Services and Claims
Entity Employing:
NEXTCARE OMAN
Job Type:
Full-Time
Remote Work:
Not Applicable
Type of Employment:
Permanent