Case Management Specialist

Allianz Services; Abu Dhabi; On-site; AED 900,000 - 1,500,000; Full time

Job summary

Allianz Partners Abu Dhabi seeks a Case Management Utilization Review Specialist to manage high-cost cases, ensure compliance, and meet timelines. You will collaborate with the Case Management team to develop protocols and provide training.

The role reports to the Assistant Manager – Case Management Utilisation Review. Requirements include MBBS and 5+ years of medical practice, insurance industry knowledge is a plus, and MS Office proficiency.

Qualifications

• Bachelor’s degree in Medicine (MBBS) required.
• 5+ years of medical practice experience.
• Knowledge of insurance industry practices is a plus.
• Legally permitted to work in the country.
• Physically fit to carry out duties.
• Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation.

Responsibilities

• Liaise with Case Management team to develop and implement protocols and provide training.
• Identify and report clinical cost drivers to plan Field Control Officers or File Reviews.
• Manage high risk and long stay cases.
• Evaluate provider and clinician abuse to flag issues and create cost-control frameworks.
• Coordinate with BD Team & Payers to manage expectations from Case Management.
• Audit and sign off monthly Case Management Savings report and share with Assistant Manager.
• Manage jumbo discounts above 250k AED claim value.
• Coordinate with Providers and vendors for cost-effective outcomes on elective cases.
• Ensure timely closure of disputed cases with insurance payers.
• Aim for monthly savings target of AED 1M and work with Audit and Fraud Waste teams.

Skills

MS Office

Education

Bachelor’s of Medicine (MBBS)

Job description

Job Description:

Case Management Utilization Review Specialist manages high-cost cases ensuring departmental goals are met, timelines are adhered to, and all compliance measures are taken care of. This report directly reports to Assistant Manager – Case Managent Utilisation Review.

What you do

• Liaise with the Case Management team to develop and implement case management protocols, as well as provide training for the team.
• Identifying and reporting clinical cost drivers to plan Field Control Officers or File Reviews.
• Managing high risk and long stay cases.
• Evaluating Provider & Clinician Abuse to red flag the team . Create a framework for cost controls.
• Coordinating with BD Team & Payers to manage the expectations from Case Management perspective
• Auditing & Signing off the monthly case Management Savings report & sharing with the Assistant Manger.
• Manage Jumbo discounts above 250k AED claim value
• Coordinate with Providers & vendors to get the best cost effective outcome for elective cases
• Ensuring timely closure of disputed cases & cases pending with insurance Payers.
• Achieve a monthly savings target of AED 1M in line with the criteria or methodology defined by the Line Manager and Head of Department.
• Work closely with the Audit and Fraud Waste team to flag providers and clinicians with activities of misrepresentation or malpractice.
• Ensure timely reviews & deicision making of High costs cases above AED 75,000.
• Assessing cases with multiple admissions and readmission to gauge the provider practice as well as investigate the medical negligence if any.
• AI READINESSWork effectively in an environment shaped by artificial intelligence (AI), machine learning, data, analytics and cloud-based tools, using insights responsibly with our standards of data governance, security and ethical use.

What you bring

• Bachelor’s of Medicine (MBBS);
• 5+ years medical practical experience (reputable insurance provider, broker or a TPA experience a plus).
• Knowledge of overall insurance industry practices is a plus.
• Legally permitted to work in the country of operations.
• Physically fit to carry out duties.
• Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.

What we offer

Allianz Partners is a world leader in B2B2C insurance and assistance, offering global solutions that span international health and life, travel insurance, automotive and assistance. Customer driven, our innovative experts are redefining insurance services by delivering future-ready, high-tech high-touch products and solutions that go beyond traditional insurance. Our products are embedded seamlessly into our partners’ businesses or sold directly to customers, and are available through four commercial brands: Allianz Assistance, Allianz Automotive, Allianz Travel and Allianz Care.

At Allianz Partners, Artificial Intelligence (AI) is transforming service delivery and innovation. By leveraging Business Intelligence and Data Analytics, we enhance strategic decision-making and customer experiences. Our commitment to Ethical AI ensures responsible deployment, maintaining data integrity and trust. Conversational AI improves communication, while Emerging Technologies and Generative AI drive industry leadership and new opportunities. With robust Information Security Management, we protect sensitive information, ensuring compliance and security. Embrace the future of AI with Allianz Partners, where possibilities become realities.