HEALTH CLAIMS ADJUSTER
Under the direction of the Claims Manager, the Health Claims Adjuster is responsible for receiving and processing the claims in an expedient manner, in order to:
• Ensure claims handled within authority limits, and in line with Claims Standards procedures and guidelines.
• Utilize third party service providers to achieve economical results and to provide a high quality service to all internal and external customers.
• Develop and maintain relationships with agency, brokers and clients.
Claims Processing and Administration: Input and maintain accurate claims records, within appropriate Claims administration systems. Proactively review late/nonpayment of premium and support control process with Underwriting . Manage timely production of management information reports (e.g. monthly major claims movements) and proactively identify loss trends.
Investigation and Reserving of Claims: Investigate standard claims, including coverage determination and evaluation of loss exposures. Determine appropriate reserving levels. Proactively discuss and review contentious, large and complex claims with fellow handlers and management to obtain opinions/feedback.
Settlement: Settle standard claims through payment or denial. Ensure unpursued claims are settled in accordance with settlement guidelines.
Referrals and Compliance: Ensue all claims handled within authority limits, and in line with Claims Standards procedures and guidelines. Refer cases outside of authority level, preparing referral documentation and materials as appropriate. Assist in audits of external service providers as appropriate.
Relationship Management: Proactively drive involvement of functional areas in Claims handling process, e.g. Underwriting, Finance. Develop and maintain relationships with key agencies, brokers and clients and other relevant stakeholders (e.g. third party adjusters). Report loss information internally and externally.
3 - 5 years of Claims Handling experience : Understanding of health insurance products and coverages with claims specialist knowledge, processing from notification to settlement and recovery.
Reserving: Expert knowledge of reserving principles and practices
IT Skills (Office Applications): Use general office application tools e.g. Power Point, Excel, Word
Analytical Skills: Ability to analyze highly complex data from multiple sources in detail and identify and resolve issues before they transpire
Communication and Presentation: Ability to express ideas and messages clearly, both written and verbally. Committed to team and continued learning culture.
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. Join us. Let’s care for tomorrow. 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.
How can we help?
International leader in assistance, travel Insurance and health, home and lifecare services, today Mondial Assistance's global family counts more than 12 700 employees who live to help. They speak 58 different languages and work hand in hand with a vast, global network of service providers and correspondents. 250 million people, or 4% of the world's total population, benefit from its services, which they provide on all five continents As the world’s leading assistance company, helping is in our DNA. And we don’t just help our customers; our caring nature extends to our employees, too. So if you live to help others and would like to work for an international network that offers nurtured career progression and really cares about its employees, contact us today and join our global family.
Everyone is welcome to apply, regardless of gender, national origin, age, religion, disability, sexual orientation or philosophy of life. Mondial Assistance is an Equal Opportunity Employer.
Job Reference: TPA-ADJ2104