Senior Claims Officer
Allianz Worldwide Partners
Total years of experience :7 years, 0 Months
o Execution of strategic initiatives, as well as operational management, quality assurance, and target delivery.
o Evaluate claims with regards to member's eligibility and makes a decision.
o Ensure correct adjudication of claims thus allowing accurate reporting in claims data. In line with the company’s policy on cost, identify duplicate payments, possible non-disclosure, and fraudulent.
o Experience in prioritizing time allocation against critical tasks and team capability by allocating and monitoring the weekly distribution of claims as per the team target.
o Logged in errors of the verified and released processed claims of my team members.
o Adjudicate and process claims within the agreed company SLA/KPIs along with the committed targets.
o Coordinate workflow and meet deadlines.
o Managed reconciliations and further information responses from the provider.
o Initiating investigation of the fraudulent claims and capturing fraud cases and duplicated claims.
o Expand medical knowledge and lesson learned through claims processing with the team members.
o Organize and lead the team meetings to align on the business objective & expected outcomes.
o Communicating with customers through various channels to resolve customer complaints via phone or walk-in customers.
o Highlight issues through feedback and recommend changes in workflows, procedures, and service levels to meet customer needs and to ensure quality service always.
o Managed all issues related to the returned Cheques.
o Checking, card re-issuance, cancellation, etc.… and disputes such as duplicated billings, etc.…, requests for Membership Reward vouchers or enrollment, etc.… and refers cases for action to the relevant departments in the main office in Bahrain.
o To respond quickly and efficiently to all in-coming sales inquiries, by telephone, fax, and email, preparing brochures as required.
o Reports lost/stolen Cards and track it until the customers receive the new cards.
o Handling the regular daily customers’ requirements (offers, samples, inquiries) and issuing the production orders accordingly.
o Track orders and update tracking spreadsheets to agents, distributors, and customers.
o Logistics operations: shipping documentations and bookings and follow-up, tracking, and problem identification.
o Managed and organized the dispatch and delivery of goods and for staying in touch with other managers in the supply chain process to ensure the management and delivery of opened orders and stock runs efficiently, and as well coordinated with the clients.
o Establishing and implementing export logistics procedures in line with organizational requirements.
o Managed large amounts of incoming calls and walk-in customers along with recording the details of customer contacts and actions are taken.
o Handle customer complaints provide appropriate solutions and alternatives within the time limits; follow up to ensure resolution.
o Managing daily reports including keeping in & out products.
