Specialist - Claim Direct (Reimbursement)

Allianz
Bangkok
Full timeFunction: Marketing & GrowthExperience: 3+ yearsEducation: bachelorsSkills: ["Attention to accuracy","Prioritization","Collaboration","Compliance","Case management"]

Assess and manage end-to-end insurance reimbursement and OPD cashless claims. Investigate cases, approve or reject payments within authorization limits, request supporting documents and hospital records, and issue system memos for administrative follow-up. Monitor pending and backlogged workloads, consolidate complex cases for Claim Committee decisions, and ensure accurate outcomes aligned with SLAs through collaboration with internal stakeholders.

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FursaFursa
Allianz
Allianz
1 week ago

Specialist - Claim Direct (Reimbursement)

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Source: Company careers pageValidated by: Fursa AI
Last checked: 21 hours agoStatus: Live

Job Summary

Assess and manage end-to-end insurance reimbursement and OPD cashless claims. Investigate cases, approve or reject payments within authorization limits, request supporting documents and hospital records, and issue system memos for administrative follow-up. Monitor pending and backlogged workloads, consolidate complex cases for Claim Committee decisions, and ensure accurate outcomes aligned with SLAs through collaboration with internal stakeholders.
Location: Bangkok
Employment Type: Full time
Job Function: Marketing & Growth
Seniority: Mid level

Key Responsibilities

  • •Investigate and make reimbursement claim assessment decisions; approve payments within authorization limits and reject when criteria aren’t met.
  • •Request additional information/documentation and obtain hospital medical records to support claim review, issuing system memos for administrative processing.
  • •Continuously monitor, review, and decide on pending, backlogged, and pending reimbursement cases.
  • •Handle OPD cashless claims submitted by hospitals: investigate, decide, approve/reject (including fax-submitted cases when applicable), and request supporting documents.
  • •Manage complex OPD cashless cases that require Claim Committee decisions and consolidate documentation for authorization-guideline-based decision-making while meeting SLAs.

Key Requirements

  • •Bachelor’s degree in Nursing Science, Medical Technology, or a related field.
  • •Minimum 3 years of experience as a Claims Assessor or in relevant insurance industry claims functions.
  • •Strong knowledge of nursing/medical concepts and insurance claim regulations, policies, and guidelines.
  • •Strong attention to accuracy and detail.
  • •Ability to prioritize claim-related tasks efficiently.
Experience:3+ yearsInsuranceHealthcare claims
Education:Bachelor's
Skills:Attention to accuracyPrioritizationCollaborationComplianceCase management
Tech Stack:MS OfficeExcelPowerPointPower BICRM systemsChatGPTMicrosoft Copilot 365

Company Brief

Allianz
Global insurance and financial services group offering property-casualty insurance, life and health insurance, asset management, and corporate risk solutions to individuals, businesses, and institutions across more than 70 countries.
Industry: Insurance
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: Munich, Germany
Founded: 1890
WebsiteLinkedIn