Senior Claims Quality & Support Associate
Job Fit Check
Base Career helps you apply smarter for this job.
Key skills for this role
About the Role
Nextcare seeks a Senior Claims Quality & Support Associate to review complex claims, mentor junior staff, and conduct retrospective audits. The role requires a bachelor's degree in a related field and 5+ years of experience in a customer-focused environment, ideally in clinical, paramedical, TPA, 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
- 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 Medical field, Paramedical, Finance, Business Administration, Insurance, or 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 received from providers of denied or incorrect payments based on contractual arrangements with providers and non contractual providers.
- Offer assistance to junior staff on challenging cases.
- Identify trends and areas for improvement in the claims process.
- Retrospective auditing of paid claims. This includes 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.
- 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.
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.
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.
- Allianz Group is one of the most trusted insurance and asset management companies in the world.
- We welcome applications regardless of race, ethnicity or cultural background, age, gender, nationality, religion, social class, disability or sexual orientation.
Apply for this job in 1 click
Skip the repetitive application forms
Install the Base Career Chrome Extension and autofill job applications across major job boards with your profile.
Trusted by over 500,000 job seekers on Base Career
More from this employer
More jobs at Nextcare
Medical Provider Performance Executive
Dubai, UAE
Nextcare seeks a Medical Provider Performance Executive to conduct investigations of healthcare providers for fraud, waste, and abuse. The role involves data mining, audits, and collaboration with legal and finance teams
Senior Operations Solution Lead -
Dubai, UAE
Nextcare seeks a Senior Operations Solution Lead to manage projects and transitions across Health Operations lines of business. The role involves developing business cases, managing schedules, risks, and stakeholder comm
Medical Provider Performance Executive
Doha, QAT
Nextcare seeks a Medical Provider Performance Executive to investigate healthcare fraud, waste, and abuse in Doha. The role involves data mining, audits, and provider relationship management. Requires clinical knowledge,
Replacement of Travel and assistance Officer
Dubai, UAE
Nextcare is seeking a Travel and Assistance Officer to manage medical assistance cases, evaluate claims, and coordinate with providers. The role requires a Bachelor's degree in a medical field, 1+ years of insurance or t
Project Specialist
Dubai, UAE
As a Project Specialist, you will manage action plans, coordinate initiatives, and support the Global Head of Claims in overseeing daily operations. The role involves driving transformative projects, managing communicati
Emiratization Specialist, UAE
Dubai, UAE
Nextcare is seeking an Emiratization Specialist to oversee the development and operation of its Emiratization program in Dubai. The role involves recruiting, developing, and retaining UAE national talent, working with go
Claims Queries Agent
Dubai, UAE
Nextcare is hiring a Claims Queries Agent to handle incoming queries from healthcare providers via phone, email, and other channels. The role requires a Bachelor's degree in a medical or related field and 2 years of cust
Claims Processing Agent
Dubai, UAE
Nextcare is hiring a Claims Processing Agent to review and handle claims, support service level agreements, and deliver exceptional customer service. The role requires a bachelor's degree in a related field and 1-2 years
Medical Provider Performance Executive
Dubai, UAE
Senior Operations Solution Lead -
Dubai, UAE
Medical Provider Performance Executive
Doha, QAT
Replacement of Travel and assistance Officer
Dubai, UAE
Project Specialist
Dubai, UAE
Emiratization Specialist, UAE
Dubai, UAE
Claims Queries Agent
Dubai, UAE
Claims Processing Agent
Dubai, UAE