Claims Quality and Support Officer

1 day ago

Brisbane, Queensland, Australia Allianz Partners Full time
Overview

Join to apply for the Claims Quality and Support Officer role at Allianz Partners.

Responsibilities
  • 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 score cards; identify error trends and training opportunities. Understands, interprets, and applies coding and reimbursement guidelines; provider and Health Plan contracts for professional claims to ensure accuracy. Audit, assess, and monitor providers and payers, including physicians, inpatient, outpatient, ancillary, behavioral healthcare, laboratory, etc.; medical records, and independently codes and abstracts. Analyze inpatient and outpatient medical records using current ICD-9/ICD-10, CPT, HCPCS, 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.
  • Prepare concise documentation and audit reports, including recommendations to claims management for improvements with corrective action plans; Special focus and priority will be given to regulatory audit requirements, reports and findings. A summary of findings will be issued on a monthly basis through a report, including recommendations on changes to be made, aligned with the Claims Quality Manager.
Qualifications
  • Bachelor's degree in any Medical field, Paramedical, Finance, Business Administration, Insurance, or a related field preferred.
  • 3-5 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.
  • Essential Skills: Other ad hoc duties as required.

Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams and challenges, is what makes us a unique employer. Allianz believes in a diverse and inclusive workforce and is an equal opportunity employer. We welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, disability or sexual orientation.

Join us. Let\'s care for tomorrow.

Seniority level
  • Mid-Senior level
Employment type
  • Full-time
Job function
  • Other
Industries
  • Financial Services and Insurance
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