Specialist - A&H Claims Investigation

About the Role

We are looking for a Claims Investigation Specialist to support our Accident & Health (A&H) claims team. In this role, you will help ensure claims are reviewed fairly, accurately, and in line with policy conditions. You'll work closely with claims, medical, and investigation teams to protect both our customers and the company.

If you enjoy detail-oriented work, problem-solving, and collaborating across teams-this role could be a great fit for you.

What You'll Do

• Review and screen insurance claims to identify cases requiring investigation (e.g. pre-existing conditions, waiting periods, or policy exclusions)
• Decide when medical documents are needed and liaise with hospitals to request relevant information
• Evaluate medical data against policy terms and recommend appropriate actions (approval, exclusion, rejection, or termination)
• Handle high-value and complex claims, including overseas and group insurance cases
• Prepare and present investigation findings to medical experts and management for payment decisions
• Provide guidance to customer service teams on policy and claim conditions
• Communicate clearly with customers regarding investigation outcomes, appeals, and claim decisions
• Review claim rejection letters (Thai & English) before sending to customers

What We're Looking For

Must Have

• Bachelor's degree in any field
• At least 2 years of experience in insurance, claims, or related services
• Nursing background with ability to communicate in English

Nice to Have

• Strong attention to detail and accuracy
• Knowledge of insurance products and policy conditions
• Good computer skills, especially MS Excel
• Familiarity with AI tools (e.g. ChatGPT, Copilot 365) is a plus

Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams and challenges is what makes us a unique employer. We are united by a shared commitment: to put our customers first and at the centre of everything we do. Their needs inspire our thinking and guide our actions. Together, we can build an environment where everyone feels empowered and confident to explore, grow and shape a better future - for our customers and for the world around us. At Allianz, we stand for unity: we believe that a united world is a more prosperous world, and we are dedicated to consistently advocating for equal opportunities for all. The foundation for this is our inclusive workplace, where people and performance both matter, and where integrity, fairness, inclusion and trust are at the heart of our culture. We therefore welcome applications regardless of ethnicity or cultural Internal background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristics protected under applicable local laws and regulations.

Join us. Let's care for tomorrow.