Pre Certification Process Lead OFR

Job description

The Precertification–Process Lead will provide quality service to clients by promptly and effectively assessing and processing claims and approval according to operations set standards. Process Lead will evaluate complicated pre-authorization claims, medical evaluations, direct claims coverage, errors, and claims turn-around time and process queries to achieve quality evaluations. Supervises the team with regards to productivity and efficiency. Key responsibilities/What you do: •Manages routine daily claims administration work. •Coordinates workflow & meet deadlines. •Evaluates claims with regards to eligibility. •Makes informed decisions on high cost and complicated cases. •International Preauthorization. •Trains and supervises team members. •Attends calls and e-mails from insurance companies, clients and providers. •Coordinates with international providers for direct billing. •Makes suggestions to improve service. •Increases efficiency, minimizing errors and administration time. •Coordinates with different departments within the company. •Monitors output. AI 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 of Pharmacy •3+ years Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus). •Legally permitted to work in the country of operations. •Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills. 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. 107880 | Physicians | Professional | Non-Executive | Allianz Partners | Full-Time | Permanent 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.