Job Description

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.