The Precertification Officer is responsible for handling received requests from external parties, checking eligibility, and issuing authorization of medical treatments and ensuring that medical treatment given by providers is necessary, appropriate and cost effective.
The Precertification Officer provides high quality service; assists and informs clients/medical providers about the authorization response.
Key responsibilities/What you do:
Receive the requests from external parties, check claims eligibility and issue authorization of medical treatments, follow up on the case and ensure that medical treatment given by providers is necessary, appropriate and cost effective. Handle details of the authorization by completing the data on TATSH in accordance with the policy wordings and the information as relayed by the relevant medical report and/or the other relevant details and gathered by the Precertification Officer. Liaise closely with the Precertification Doctor in the pre-authorization of treatments and appropriate medical care for all in-patient claims and any other type of claim costly, suspicious or complicated whereby claim doctor medical approval & signature is required. Discuss the authorization’s details with clients and provide sympathetic support and both medical and procedural advice as appropriate Liaise closely with the Team Leader / Deputy Precertification Manager in the pre-authorization of treatments and appropriate medical care as per policy terms and conditions; suggesting the intervention of field medical officers/second medical opinions for suspicious, difficult and major cases Report in writing to the supervisor regarding complaints received by the Precertification department and relating to a specific communication and/or authorization process. Provide a high quality service, assist and inform clients/medical providers about the authorization response and make sure that clients’ requests are handled with no delay and with efficiency. Follow and apply the internal claims procedures for all types of claims Responsible and accountable for the confidential, proper administration of insured member data as well as system, policy and medical information Any other duties as requested by the Direct Manager Welcome and assist patients politely and professionally; display a positive attitude towards customers. Maintain a good professional relation with providers and staff To show a positive image of NEXtCARE Ensure daily medical follow-up, communicate all information to the assigned colleague at the Regional Office / Precertification Center Check bill upon patient’s discharge and share the bill amount with the assigned colleague Receive bills from providers when applicable as per internal procedure Attend regular meeting / training sessions as directed by Direct Manager
Key requirements/What you bring:
Education: Bachelor of Nursing required Experience: Minimum 5 year's experience within the Health Care Industry (TPA’s, Insurance companies, Hospitals, Medical Centers) Physically fit to carry out duties. Legally permitted to work in the country of operations. Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.
Key benefits/What we offer:
Our employees play an integral part in our success as a business. We appreciate that each of our employees are unique and have unique needs, ambitions and we enjoy being a part of their journey.
We are there to empower and encourage you with your personal and professional development ensuring that you take control by offering a large variety of courses and targeted development programs. All that in a global environment where international mobility and career progression are encouraged. Caring for your health and wellbeing is key priority for us. This is why we build Work Well programs to providing you with peace of mind and give the flexibility in planning and arranging for a better work-life balance.
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. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow and to shape a better future for our customers and the world around us.
We at Allianz believe in a diverse and inclusive workforce and are proud to be an equal opportunity employer. We encourage you to bring your whole self to work, no matter where you are from, what you look like, who you love or what you believe in.
We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, disability or sexual orientation. Join us. Let's care for tomorrow.