Claims Quality & Support Associate

Overview

• What you do
• Responsible for activities concerned with review and inspection to apply quality standards for operational claim processes and adjudication.
• Creates clear and accurate audit findings and recommendation in written audit processing status codes that provides feedback to examiners used in examiner score card, identifies error trends and training opportunity.
• Understands, interprets, and applies coding and reimbursement guideline; provider and Health Plan contracts for professional claims to ensure accuracy.
• Audit, assess, and monitor providers and payers, to include but not limited to physicians, inpatient, outpatient, ancillary, behavioral healthcare, laboratory, etc. medical records, and independently codes, and abstracts.
• Analyze inpatient and outpatient medical records using most current International Classification of Diseases (ICD-9/ICD-10),Current Procedural Terminology (CPT), Health Care Common Procedure Coding System (HCPCS), Universal Billing (UB) and other codes, regulatory and contractual requirements, and generally accepted coding practices.
• Verify and validate claims documents received through multiple channels to rule out possibility of documentation / coding errors or other inconsistencies that may occur in case of suspected fraud and abuse cases.
• Prepare concise documentation and audit reports, including recommendations to claims management for improvements with corrective action plans;
• Special focus and priority will be given to regulatory audit requirements, reports and findings.
• A summary of findings will be issued on monthly basis through a report, including recommendations on changes to be made, aligned with the Claims Quality Manager
• Other Ad hoc duties as required.
• 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 degree in any Medical field, Paramedical, Finance, Business Administration, Insurance, or a related field preferred.
• 3-5 years’ experience in a customer focused environment, ideally in clinical, paramedical roles or TPA or insurance roles.
• Demonstrated understanding of medical claims processes and procedures, and ability to recognize and interpret variances
• Proficiency in MS Office and general internet navigation and research skills
• Must be detail oriented and have the ability to work independently
• Legally permitted to work in the country of operations.
• Hybrid working option available as per business requirements.
• How we hire Agency Statement Allianz Partners does not accept unsolicited CV’s or approaches from agencies.
• We only work with partners on our approved supplier list, under contract.
• Any unsolicited submission will not be considered
• 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.
• 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 center 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 race, ethnicity or cultural background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristics protected under applicable local laws and regulations.
• Great to have you on board.Let's care for tomorrow.
• **Note:** Having different strengths, experiences, perspectives and approaches is an integral part of Allianz‘ company culture.
• One means to achieve this is a regular rotation of Allianz employees across functions, Allianz entities and geographies.
• Therefore, Allianz expects from its employees a general openness and a high motivation to regularly change positions and collect experiences across Allianz Group.