Senior Claims Quality and Support Officer

Job description / Role

Key responsibilities / 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.

Key requirements / 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.

How we hire: Allianz Partners does not accept unsolicited CVs or approaches from agencies. We only work with partners on our approved supplier list, under contract. Any unsolicited submission will not be considered.

About the Company

With over 159,000 employees from 172 nationalities across more than 70 countries, we are one of the world's most trusted insurance and asset management companies. We offer a broad range of products and services in property/casualty insurance, life/health insurance, and asset management. We have our largest operational presence in Europe, and our parent company, Allianz SE, is headquartered in Munich, Germany. From jobs in Actuarial, Business and IT to Inhouse Consulting and Investment Management - your opportunities are endless!