Specialist
Allianz Ayudhya
Posted
3 weeks ago
Bangkok, Bangkok City, Thailand
Remote
THB 60K
Mid Level
Full Time
Sema Summary
The role involves managing concurrent processes in case management according to medical necessity policies. Responsibilities include reviewing claims, managing treatment, and ensuring cost containment.
About Company
Allianz Ayudhya is a leading insurer in Thailand, part of the Allianz Group, which is known for its commitment to customer care and employee empowerment.
Core Requirements
- Minimum 3 years nursing experience
- Experience in critical units like ER, ICU, or OR
- Strong interpersonal and communication skills
- Ability to work in a fast-paced commercial environment
- Familiarity with AI tools like ChatGPT or CoPilot 365
Responsibilities
- Manage concurrent process or case management team.
- Conduct daily concurrent reviews of long stay admissions.
- Review claims and medical reports for assessment.
- Ensure appropriate treatment for high claiming members.
- Verify eligibility of claims and manage length of stay.
- Consult with medical consultants for guideline deviations.
- Detect and report suspicious claims to governance teams.
Must Have skills
Job Keywords
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