Case Management Lead

We are seeking a dedicated and dynamic Case Manager to join our Allianz Partners NEXtCARE - Third-Party Administrator (TPA) team. The Case Manager will be responsible for managing the end-to-end process of claims, ensuring timely resolution and providing exceptional service to our clients and policyholders. This position requires a keen eye for detail, strong communication skills, and the ability to manage complex cases effectively within a fast-paced environment.

**Key Responsibilities

**

• Case Management:
• Manage and oversee the entire claims process for assigned cases, ensuring all necessary actions are taken from initial claim intake to resolution.
• Serve as the primary point of contact for both internal and external stakeholders (clients, policyholders, healthcare providers, and insurers) throughout the claims process.
• Evaluate claims for eligibility, benefits, and coverage, ensuring that all claims are processed efficiently and according to company policies and procedures.
• Active case management for high-cost elective cases for home country, SMO and long-term care routing.
• Physical regular file audits in the facilities for effective evaluate and manage over utilization, malpractice, iatrogenic injuries, mismanagement, mis presentation, retrospective audits, up-coding of DRGs, cost containment, also to control average claim cost and average length of stay.
• Cla...

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