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MEDICAL CLAIMS ADVISOR
Company:ALLIANZ WORLDWIDE CARE LIMITED |
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Job Reference Number |
13537358 |
Client ID: |
RI/AWC-2009-18 |
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Posted On: |
Jul 8 2009 |
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Location: |
PARKWEST, DUBLIN SOUTH |
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Job Type: |
Permanent |
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Salary: |
COMPETITIVE |
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Department: Claims Department
Reporting to: Claims Manager
Role Description:
To support the daily activities of the Claims Department, through claims review, case management and providing medical knowledge & support within the department as required.
The applicant must be able to maintain effective and collaborative relationships with internal departments as well as external relationships with hospitals /physicians whilst being conscious of our relationship with brokers and policy holders.
Main Responsibilities & Duties:
1) Conduct Medical claims review in relations to claims adjudication.
2) Case management of complex cases
3) Auditing of In-patient and Out-patient medical claims
4) Support the claims team in the evaluation of medical appropriateness
5) Provide medical advice/knowledge to colleagues in the claims department.
6) Prepare and provide case and medical training for claims department.
7) Support the department’s efforts to achieve cost containment and achievement of the targeted loss ratio.
8) Prepare and provide medical training for the Claims team in partnership with the Medical director.
Necessary Qualifications / Skills:
1) Qualified Registered General Nurse, preferably with post-graduate specialist subject.
2) Experience within a medical Insurance provider or within the management function of a medical provider
3) Oral & written fluency in English
4) Be proactive and have the ability to work under pressure
5) Be organised, efficient, and results oriented
6) Flexibility
Remuneration will be competitive and includes an attractive benefits package
