Senior Claims Quality & Support Associate
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Key skills for this role
About the Role
Allianz Partners seeks a Senior Claims Quality & Support Associate to review complex claims, mentor junior staff, and ensure compliance. Requires 5+ years in a customer-focused environment, ideally in clinical, paramedical, or insurance roles.
Key Skills for This Role
Responsibilities
- Review complex and high cost claims to determine financial and risk accuracy
- Offer assistance to junior staff on challenging cases
- Identify trends and areas for improvement in the claims process
- Retrospective auditing of paid claims, flagging overpaid claims for recovery
- Prepare concise documentation and audit reports with recommendations to claims management
- Mentor and coach new and existing staff on best practices and company policies
- Ensure claims handling complies with company policies, industry regulations, and legal requirements
Requirements
- Bachelor’s degree in any Medical field, Paramedical, Finance, Business Administration, Insurance, or a related field preferred
- Minimum 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
- Proficiency in MS Office and general internet navigation and research skills
- Detail oriented and ability to work independently
- Legally permitted to work in the country of operations
Full Job Posting
What you do
- Review of complex and high cost claims to determine financial and risk accuracy and in depth review of written dispute requests.
- Offer assistance to junior staff on challenging cases.
- Identify trends and areas for improvement in the claims process.
- Retrospective auditing of paid claims, including flagging of overpaid claims for recovery.
- Prepare concise documentation and audit reports, including recommendations to claims management for improvements with corrective action plans.
- Mentor and coach new and existing staff on best practices and company policies.
- Ensure claims handling complies with company policies, industry regulations, and legal requirements.
- Other Ad hoc duties as required.
- Work effectively in an environment shaped by artificial intelligence, machine learning, data, analytics and cloud based tools.
What you bring
- Bachelor’s degree in any Medical field, Paramedical, Finance, Business Administration, Insurance, or a related field preferred.
- Minimum 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.
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