Sr. Specialist - AAGI A&H Claims Investigation

Nice to know

This position is assigned to provide investigation support services to Claim Assessor, Pre-authorization team and Underwriting team. This position will plan the investigation cases and resources to ensure that the investigation cases are performed in timely manner. And provides administration support for policy voidance.

Your Day at Allianz Ayudhya

1. Investigation

• Select the location for investigation to investigate administration team for checking and request medical history from selected hospitals.
• Review medical histories and report back to owners (Claim team, Pre-authorization team, Underwriting team) for further assessment

2. Administration Support

• Support for claim consulting from Claim team, Sale team, CS team etc.
• Support for medical training to claim team (CPU1, CPU2, ASO, Fax claim)

3. Policy voidance

• Review and summary medical history
• Propose case to claim management for policy voidance
• Prepare void letter
• Inform membership team to refund premium
• Explain void reason to customer and related parties (If any)

Must Have

• Degree in Nursing Science, Business of Sciences (Medical Technology), or related field
• Minimum 5 Years of experience in Claims Assessor or other related fields in insurance industry
• Experience of claims workflow, systems and Prioritization & Queue management
• Strong medical knowledge

Nice to Have

• Ability to prioritize claim related functions
• Attention to Detail (Accuracy Control)
• Fraud / Abuse Awareness
• MS Office: MS Word, Excel, PowerPoint, Outlook, SharePoint
• Any AI-future skills e.g., ChatGPT, or CoPilot365, will be advantage.