Claims Quality & Support Officer

Job description / Role

The Quality Assurance Officer is responsible for activities concerned with review and inspection to apply quality standards for operational processes.

What you do

• Monitor the quality of all operational transactions.
• Analyze inpatient and outpatient medical records using the most current International Classification of Diseases (ICD-9/ICD-10), Current Procedural Terminology (CPT), regulatory and contractual requirements, and generally accepted coding practices.
• Verify and validate claims documents received through multiple channels to rule out the possibility of coding errors or other inconsistencies.
• Responsible for activities concerned with review and inspection to apply quality standards for operational claim processes and adjudication.
• Create clear and accurate audit findings and recommendations in written audit processing status codes that provide feedback to examiners used in examiner scorecards, identify error trends, and training opportunities.
• Understand, interpret, and apply coding and reimbursement guidelines; provider and Health Plan contracts for professional claims to ensure accuracy.

What you bring

• Problem-solving skills, analytical skills, decision-making skills, ability to work in a team environment, knowledge of applicable quality standards.
• Bachelor's of Pharmacy / Medicine.
• Minimum 2 years' experience from insurance/providers in processing/adjusting claims (e.g. ICD-9/10, CPT).
• 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.

What we offer

Our employees play an integral part in our success as a business. We appreciate that each of our employees is unique and has unique needs and ambitions, and we enjoy being a part of their journey. We are there to empower and encourage you with your personal and professional development, ensuring that you take control by offering a large variety of courses and targeted development programs. All that in a global environment where international mobility and career progression are encouraged. Caring for your health and wellbeing is a key priority for us. This is why we build Work Well programs to provide you with peace of mind and give the flexibility in planning and arranging for a better work-life balance.

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!