Claims Management - Team Leader, Allianz

Allianz

Location:
Tunisia, Tunis

Category:
Insurance

Contract Type:
Not provided

Salary:

Not provided

Save Job

Apply Position

Job Description:

The Claims Management – Team Leader is responsible to review high-cost Reimbursement Claims, direct claims /Reimbursement Claims coverage, manage medical evaluations, errors and claims turn-around-time and processors queries to achieve quality decisions and evaluations.

Job Responsibility:

Audit, evaluate, process, and validate claims, with regards to eligibility as per Nextcare terms and conditions
Communicate policy and rules to Reimbursement Claims evaluations team Maintain records of direct claims errors and provide resolution to avoid further mistake
Re-evaluate resubmissions
Monitor Backlog, Daily productivity, Pending cases, In-patient cases, Claims entered in TATSH, Reimbursement Team attendance details and shift schedules, Detection of errors, Turn-around-time (TAT) of international claims
Supervise trackers, evaluators, and processors of the Reimbursement team
Prepare and maintain weekly and monthly report for resubmissions, audit results, pay orders rectification, insurance company’s direct claims, direct claims error/wrong report denials and international claims status and evaluation
Rectify P.O’s as returned by insurance companies
Respond provider/customers any issues related to claims settlement as to be reviewed by policy
Provide decisions for claims officers and processors with regards to claims coverage Monitor and participate in quality control reviews
Supervise Reimbursement team claims officers on their monthly achievement and performance
Increase efficiency by minimizing errors and administration time
Provide feedback to internal and external customer queries in a professional demeanor
Deal with urgent and non-urgent situations involving insured payers/BDU
Provide individualized administrative service and assists insured members in obtaining high quality, cost-effective healthcare
Perform autonomous duties including Claims coverage decision requiring specialized knowledge, judgment, and skill within the guidelines of Nextcare’s policies and procedures
Responsible and accountable for the confidential, proper administration of insured member data as well as system, policy and medical information Responsible for utilizing medical knowledge base, effectively collaborating and promoting collegial relations to enhance the quality and cost-effectiveness of healthcare of insured members
Assist in creating action plans in response to errors/audits
Recruit, train, and supervise staff
Internal Business Processes
Communicating performance data 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 feedback on their output and performance
Develop and recommend improvement of facilities, equipment, or procedures to improve safety, quality, and efficiency
Monitor usage of utilities to ensure efficiency
establish a culture of continuous improvement in a safe working environment
Co-ordinate regular meetings with staff

Requirements:

Bachelor’s Degree: Medical background preferred
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
Legally permitted to work in the country of operations
Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills

What we offer:

Large variety of courses and targeted development programs
International mobility and career progression
Work Well programs for health and wellbeing
Flexibility in planning and arranging for a better work-life balance

Additional Information:

Job Posted:
May 19, 2025

Employment Type:

Fulltime

Work Type:

Hybrid work

View All Jobs In This Company

Job Link Share:

Claims Management - Team Leader