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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing outpatient precertification claims, ensuring compliance with policy terms and quality standards while utilizing data analytics and coding guidelines. Proficient in assessing medical necessity and coordinating with healthcare providers to facilitate effective treatment plans.
Highest-signal resume keywords
Outpatient Precertification ManagementMedical Claim AdjudicationCPT and ICD Coding GuidelinesCertified Medical Coder CertificationData Analytics and AI Utilization
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical Claim AdjudicationCPT CodingICD CodingUtilization ReviewMedical Documentation ReviewCost-Containment ProtocolsEvidence-Based Guidelines AssessmentOutpatient Benefit StructuresCompliance MeasuresQuality Standards
Soft Skills
Attention to DetailCommunication SkillsOrganizational SkillsProblem-Solving SkillsTeam Collaboration
Tools & Technologies
MS OfficeData Analytics ToolsCloud-Based ToolsAI ToolsMachine Learning Tools
Certifications & Qualifications
Certified Medical Coder Certification
Industry Keywords
Outpatient ServicesInsurance RegulationsHealthcare ComplianceMedical NecessityHealthcare Documentation
Tech Stack
Tools & technologiesCloud
About the role
Key responsibilities & impact- Manage outpatient precertification claims while meeting departmental goals, activity timelines, and compliance measures
- Work flexible shifts according to the Team Leader’s schedule in a 24/7 precertification team
- Adjudicate outpatient medical claims from technical and clinical perspectives
- Ensure decisions comply with policy terms and conditions, turnaround times, and quality standards
- Review outpatient documentation, including consultation notes, diagnostic reports, laboratory results, radiology findings, prescriptions, treatment plans, and follow-up notes
- Assess medical necessity and appropriateness of proposed treatment plans against evidence-based guidelines and outpatient benefit structures
- Request additional medical documentation and coordinate with providers when clarification is needed
- Conduct utilization reviews of outpatient services, billed items, non-covered services, overutilization patterns, investigations, and procedures
- Review claims according to CPT and ICD coding guidelines and insurance regulators’ requirements (DHA, DOH/HAAD, MOH)
- Apply cost-containment protocols and verify alignment with network rules and negotiated tariffs
- Maintain daily productivity and service-level targets for timely adjudication and consistent workflow management
- Use AI, machine learning, data, analytics, and cloud-based tools responsibly according to data governance, security, and ethical-use standards
Requirements
What you’ll need- Bachelor’s degree in Pharmacy, Dentistry, Medicine, Nursing, Physiotherapy, or Paramedics
- 01–02 years of medical practical experience; reputable insurance provider, broker, or TPA experience is a plus, or entry-level candidates may apply
- Physically fit to carry out duties
- Certified Medical Coder certification preferable
- Legally permitted to work in the country of operations
- Fluency in MS Office (Excel, Word, Outlook, PowerPoint)
- General internet navigation and research skills
Benefits
Comp & perks- AI readiness and exposure to artificial intelligence, machine learning, data, analytics, and cloud-based tools
- Inclusive workplace with equal-opportunity employment practices
- Opportunities to grow and collect experiences across Allianz Group through regular rotation across functions, entities, and geographies
- Employment with Allianz Partners, a global B2B2C insurance and assistance provider
- Permanent employment