Health Underwriter
Allianz -
New Cairo, CairoPosted 5 years ago202Applicants for1 open position
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Job Description
- Responsible for the auditing function for all health claims assessed by external claims management companies, and the medical underwriting funcition for individual and corporate health products.
- Responsible for the implementation of a robust and comprehensive auditing function for all health claims assessed by external claims management companies.
- The monitoring and analysis of health claims data ensuring alignment with base utilization assumptions and market medical services costs.
- Making recommendations on acceptance of the risk if within company underwriting limit or referring the case to re-insurers if above these limits.
- Processing and issuing all standard and complex policies and endorsements
- Preparation of regular MIS reports regarding utilization and Medical provider costs.
- The ongoing enhancement of business procedures ensuring maximum efficiency of processes.
- Reimbursement process handling from submitting claims until delivering payment with regular reports on TAT and transfer ratio.
- Handling complaints within agreed SLA and reporting them on daily basis.
- Issuing all payments related to TPA and extracting all the reports needed for settlement of payments
- Dealing with the TPA in all its processes and arranging regular meetings with reporting MOM
- Creating quotations and handling negotiations and referrals with the reinsurer
- Renewal process handling regarding corporate and individual policies following our agreed guidelines .
Job Requirements
- Previous experience in medical claims processing or auditing at least 1 year
- Post graduate medical degree
