Claims Quality & Support Associate

Overview

• The Claims Quality Support Associate is responsible for activities concerned with review and inspection to apply quality standards for operational claim processes and adjudication.
• Key responsibilities/What you do:
• Prepare concise documentation and audit reports, including recommendations to claims management for improvements with corrective action plans;
• 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.
• AI READINESS Work 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
• Key requirements/What you bring:
• Bachelor’s Degree (Medical Degree or Nursing)
• Minimum 5 years’ experience from Providers/TPA’s in processing/adjusting claims (e.g. ICD-9/10, CPT, HCPC)
• Minimum 3 years’ experience auditing experience
• Demonstrated understanding of medical claims processes and procedures, and ability to recognize and interpret variances
• Legally permitted to work in the country of operations.
• Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills
• How we hire 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.
• Key benefits/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.
• Present in 75 countries, our 21,100 employees speak 70 languages, handle over 71 million cases each year, and are motivated to go the extra mile to offer peace of mind to our customers around the world.
• We at Allianz believe in a strong inclusive culture that encourages people to speak their minds, get involved and question the status quo.
• We are proud to be an equal opportunity employer and encourage you to bring your whole self to work, no matter where you are from, what you look like, who you love, or what you believe in.
• We therefore welcome applications regardless of race, ethnicity or cultural background, age, gender, nationality, religion, social class, disability, sexual orientation, or any other characteristics protected under applicable local laws and regulations.
• At Allianz Partners, AI is revolutionizing customer service and claims management through innovative solutions.
• These AI-driven tools enhance productivity by streamlining complex claims processes, reducing administrative burdens, and accelerating resolution times.
• Our AI-powered technology has made claims processing faster, offering quicker resolutions.
• All while ensuring human oversight for claims to maintain service integrity.
• By embracing AI and Emerging Technologies, Allianz Partners continues to lead the industry, meeting ever-changing customer needs with innovative solutions.
• Our commitment to Ethical AI practices safeguards data integrity and trust, ensuring responsible deployment across all operations.
• This approach not only enhances customer experiences but also supports strategic initiatives like fraud detection and personalized product offerings, solidifying Allianz Partners' position as a leader in the insurance sector.
• Great to have you on board.
• Let's care for tomorrow.