Medical Claims Officer - Pharmacist only

Job description

A Medical Claims Officer delivers high-quality service to clients by promptly and accurately assessing, processing, and approving claims in line with operational standards. A Senior Medical Claims Officer also drives team success by setting, implementing, and monitoring individual and group objectives, ensuring strict compliance with company policies and procedures.

Key responsibilities/What you do

Evaluate medical approvals and policy applications. Guide Medical Claims Officers in managing complex medical cases, enhancing both quality and productivity. Maintain meticulous attention to detail and quality, leveraging AI analytics to ensure consistency and precision. Offer second opinions on cases with uncertain treatment plans. Review high-cost claims, make informed decisions on complicated cases, and communicate sensitively with the Precertification and other departments, upholding confidentiality while using AI tools to support communication.

Provide clear, constructive feedback to the Call Centre team. Explain declined medical claims to clients with clarity. Handle routine daily claims administration efficiently. Coordinate workflow to meet deadlines. Deliver on-the-job training to team members as needed A I READINESS Work effectively in an environment shaped by artificial intelligence (AI), machine learning, data, analytics and cloud-based tools, using insights responsibly with our standards of data governance, security and ethical use.

Key requirements/What you bring

Bachelor’s degree in Pharmacy. Practical medical experience with a reputable insurance provider, broker, or TPA is advantageous; entry-level candidates are also considered. Strong verbal and written communication skills. Flexibility and excellent interpersonal abilities. A collaborative team player. Keen attention to detail and commitment to quality. Ability to work effectively with all levels of internal management, staff, and external clients.

Competence in training other staff members. Skilled in communicating sensitively and effectively with the Precertification and other departments, respecting strict confidentiality requirements. Use AI insights to enhance collaboration and teamwork. Initiative-driven, able to work flexibly under pressure and meet tight deadlines. How we hire Agency Statement Allianz Partners does not accept unsolicited CV’s or approaches from agencies.

We only work with partners on our approved supplier list, under contract. Any unsolicited submission will not be considered Key benefits/What we offer Allianz Partners is a world leader in B2B2C insurance and assistance, offering global solutions that span international health and life, travel insurance, automotive and assistance. Customer driven, our innovative experts are redefining insurance services by delivering future-ready, high-tech high-touch products and solutions that go beyond traditional insurance.

Our products are embedded seamlessly into our partners’ businesses or sold directly to customers, and are available through four commercial brands: Allianz Assistance, Allianz Automotive, Allianz Travel and Allianz Care. At Allianz Partners, Artificial Intelligence (AI) is transforming service delivery and innovation. By leveraging Business Intelligence and Data Analytics, we enhance strategic decision-making and customer experiences.

Our commitment to Ethical AI ensures responsible deployment, maintaining data integrity and trust. Conversational AI improves communication, while Emerging Technologies and Generative AI drive industry leadership and new opportunities. With robust Information Security Management, we protect sensitive information, ensuring compliance and security. Embrace the future of AI with Allianz Partners, where possibilities become realities.

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.

At Allianz, we stand for unity

we believe that a united world is a more prosperous world, and we are dedicated to consistently advocating for equal opportunities for all. And the foundation for this is our inclusive workplace, where people and performance both matter, and nurtures a culture grounded in integrity, fairness, inclusion and trust. We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristics protected under applicable local laws and regulations.

Great to have you on board. Let's care for tomorrow.

Note

Having different strengths, experiences, perspectives and approaches is an integral part of Allianz‘ company culture. One means to achieve this is a regular rotation of Allianz Executive employees across functions, Allianz entities and geographies. Therefore, the company expects from its employees a general openness and a high motivation to regularly change positions and collect experiences across Allianz Group.