Medical Provider Performance Senior Executive 1
UAE, United Arab Emirates
Job Description
We are Allianz Partners. The leader in assistance and insurance solutions in the areas of international health, assistance, automotive and travel insurance. Allianz Partners is a global family of over 19,000 employees across 78 countries. This role is in the International Health part of the business, which has a number of well-known customer facing brands such as Allianz Care, Nextcare and Medi24.
The International Health line of business provides international health, life and disability insurance and services, reinsurance and administration services to a wide range of customers. These include multinational companies, intergovernmental organisations (IGOs), non-governmental organisations (NGOs), private individuals, families and students. Our mission is to ensure that customers have access to quality healthcare through our support, care and commitment to go the extra mile. We are a truly global health partner for our customers, ensuring fast and simple access to the best advice, treatment and value for our customer.
The International Health line of business provides international health, life and disability insurance and services, reinsurance and administration services to a wide range of customers. These include multinational companies, intergovernmental organisations (IGOs), non-governmental organisations (NGOs), private individuals, families and students. Our mission is to ensure that customers have access to quality healthcare through our support, care and commitment to go the extra mile. We are a truly global health partner for our customers, ensuring fast and simple access to the best advice, treatment and value for our customer.
Summary:
This position is responsible for conducting objective, fair, thorough, unbiased and timely investigations of healthcare fraud and abuse committed against Allianz group or its Payers by members, providers, or other entities whist monitoring best of relationships with all parties. The position requires ingenuity and creativity to obtain case information not readily available, along with the ability to work independently with minimum supervision. Good organizational skills are needed to manage a high volume of assigned cases as well as the regular exercise of independent judgment and initiative to investigate allegations. The investigator must have the analytical ability necessary to review, interpret and evaluate relevant information essential in resolving sensitive and complex investigations.
Main Responsibilites:
- Fraud Abuse and Waste detections and prevention from Medical providers for allocated regions/countries
- Support the Medical Provider Performance Manager with all administration and support tasks to drive Fraud detections and prevention.
- Participate in onsite Audits, in-house claims audit and Mystery shopping campaigns
- Data mining and data analysis are required for conducting investigations on provider claims.
- Support and drive the savings target strategy as set by the Global head of MPM.
- Review files, gather information, collect evidence to detect fraud and abuse on claims.
- Assesses the scope and determine the methodology needed to carry out an efficient investigation.
- Prepare comprehensive investigative reports and analysis
- Document all evidence obtained in the investigation in order to substantiate meritorious claims, to deny unjustified claims, to recover inappropriate payments or to recommend action against responsible parties.
- Collaborates and communicates internally with associated department’s ie legal, finance, claims operations as well as external clients and Providers.
- Consults with legal and regulatory authorities for cases that may involve legal action.
- Manages and ensures generation of periodic dashboards
- Participates in specialized projects and assignments related to procurement, as required.
- Maintains provider relationship in coordination with MPM team
- Uses judgment, diplomacy and confidentiality with respect to the complete procurement process, ensuring integrity.
- Preserves the reputation of company, beneficiaries, payers and all other parties Involved. Participates in specialized projects and assignments related to procurement, as required.Minimum Requirements:
- Hold a degree or relevant qualifications
- Expertise in general industry trends.
- A thorough knowledge of the various types of insurance fraud and the strategies and techniques used in their investigation and of federal and state regulations
- Strong interpersonal/relationship skills.
- Excellent written and verbal communication skills used for interviewing and corresponding with claimants, attorneys, doctors, law enforcement, etc.
- A high degree of integrity, dependability, accountability and confidentiality is required for handling information that is considered personal and confidential.
- Ability to analyze data and interpret results.
- Ability to adapt, meet the changing demands of work environment, any delays or other unexpected demands.
- Ability to treat people with respect under all circumstances, instill trust in others besides upholding the values of organization.
- Ability collaborate and work with internal and external colleagues to successfully complete the defined tasks and provide superior customer service.
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Job Detail
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Job IdJD1410482
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IndustryNot mentioned
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Total Positions1
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Job Type:Full Time
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Salary:Not mentioned
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Employment StatusPermanent
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Job LocationUAE, United Arab Emirates
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EducationNot mentioned