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Responsible for managing IPD Cashless claim operations, ensuring compliance with policies and service level agreements (SLAs). Oversee team performance and developing skills, optimize processes, and coordinate with hospitals and other related stakeholders to resolve complex issues while ensuring timely claim payments.

Your Day at Allianz Ayudhya

• Oversee and manage the end-to-end process of IPD cashless claims, ensuring compliance with policy terms and conditions, company policies and standards.
• Supervise and guide the team in handling claim approvals, ensuring accuracy, timeliness, and adherence to service level agreements (SLAs).
• Plan and allocate tasks, closely monitor team performance to achieve SLA and service quality targets, including real-time monitoring.
• Organize and manage team rosters to ensure full coverage and optimize efficiency and effectiveness of service delivery.
• Develop team skills and knowledge through training and coaching to enhance operational efficiency.
• Monitor and review sample cases for OFR review.
• Coordinate with relevant departments to resolve issues and improve processes.
• Provide guidance and resolve complex claim issues for hospitals and customers.
• Monitor and utilize daily and monthly reports on service volume and turnaround time to manage team performance and ensure achievement of SLA target.
• Be the consultant and mentor by advising and coaching both team members and outsources.
• Continuously monitor pending cases and make decisions to clear backlog of IPD cashless cases promptly.
• Ensure timely payment of IPD cashless claims to hospitals in accordance with SLA and contractual agreement

Must Have

• Degree in business administration, Nursing, Business Sciences (Medical Technology) or related field.
• Minimum 10 years of experience in Health Insurance, Medical or Claims Management
• Experience in team/people management
• Data analytical and problems-solving skills

Nice to Have

• Strong knowledge and experience in:
  • Cashless claim processes and hospital networks
  • SLA management and quality control
  • Problem-solving and cross-functional coordination
• Experience in data analysis and process improvement is an advantage

• Strongly project management, communication, negotiation and presentation skills
• Any AI-future skills e.g., ChatGPT, or CoPilot365, will be advantage