Summary:
The Precertification Team Leader supervises officers within the team’s area of responsibility in Precertification department with the end result of achieving their respective targets in addition to clients satisfaction.
This role has the overall responsibility to manage pre-authorization claims work, coordinate activities within team and ensure facilities and processes conform to NEXtCARE standards by efficiently managing quality systems, errors, officers queries and TAT (Turn Around Time) to achieve immediate and short-term objectives quality decisions and evaluation.
Key requirements/What you bring:
Audit, evaluate, process and validate claims, with regards to eligibility as per policy terms and condition. Monitor daily output; number of claims evaluated and participate in quality control reviews Supervise officers and manages own to meet our daily and monthly targets. Train, communicating policy and rules related to pre-authorization claims to officers assigned to his/her specific work area. Supervise and coordinate team’s attendance and report to Assistant Claim Manager to take the necessary action for cover during any staff absence Audit performance on periodic basis to ensure alignment with policies and procedures. Set up and maintain operating reports as directed by the Assistant Precertification Manager / Precertification Manager to monitor the team work and performance, Attend to high cost claims prior to approval and approve authorization according to the predefined levels of authority Liaise closely with the Precertification Doctor / Department Manager as and when needed; suggest sending second medical opinion to the Assistant Claim Manager/Claim Manager Assist and inform clients/medical providers about the authorization response; discuss the authorization’s details with clients and provide a high quality service, sympathetic support and both medical and procedural advice as appropriate in a professional demeanor Deal with urgent and non-urgent situations involving insured members, families, insurance companies, hospital personnel and NEXtCARE. Provide written feedback to insurance companies, clients when necessary and as per NEXtCARE claims procedure Report in writing to the Assistant Claim Manager/Claim Manager regarding complaints received by Precertification and relating to a specific communication and/or authorization process. Daily management of customer complaints and internal relations Receive the requests from external parties, and issue authorization of medical treatments, ensure follow up and that medical treatment given by providers is necessary, appropriate and cost effective in coordination with the field officer Communicate employee performance as such would be related to quality/quantity aspects to allow for proper recognition of work evaluations. Active involvement in the implementation and continuous improvement of TAT. Provide employee feedback on their out put and performance. Develop and recommend improvements of facilities, equipment, or procedures to improve safety, quality, and efficiency Monitors usage of utilities to ensure efficiency of establish a culture of continuous improvement in a safe working environment. Coordinate regular meetings with staff 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
Key responsibilities/What you do:
Education: Bachelors of nursing required Experience:5+ Years of experience in TPA or Hospitals or in a similar role 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.