Claims Quality and Support Officer
3 weeks ago
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.
- 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
- Full-time
- Other
- Financial Services and Insurance
-
Claims Officer
3 weeks ago
Brisbane, Queensland, Australia Pacific Claims Pty Ltd Full timeOverviewAs a Claims Officer, you will be responsible for triaging incoming Claims. You\'ll work alongside our high performing and dedicated team of Loss Adjusters, and assist in progressing claims towards settlement. This role is Brisbane based.About Pacific ClaimsPacific Claims has been operating since 1995 and is a respected industry leader as Chartered...
-
Claims Officer
3 weeks ago
Brisbane, Queensland, Australia Pacific Claims Pty Ltd Full timeOverviewAs a Claims Officer, you will be responsible for triaging incoming Claims. You\'ll work alongside our high performing and dedicated team of Loss Adjusters, and assist in progressing claims towards settlement. This role is Brisbane based.About Pacific ClaimsPacific Claims has been operating since 1995 and is a respected industry leader as Chartered...
-
Claims Quality and Support Officer
3 weeks ago
Brisbane, Queensland, Australia Allianz Partners Full timeOverviewJoin to apply for the Claims Quality and Support Officer role at Allianz Partners.ResponsibilitiesResponsible 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...
-
Support Claims Quality
2 weeks ago
Brisbane, Queensland, Australia beBeeQuality Full time $68,000 - $71,900Job Overview:The role of Quality Assurance Specialist is pivotal in supporting a team with ad-hoc administration across multiple projects by ensuring quality assurance within motor insurance claims.This challenging position involves working collaboratively, providing feedback on claims management, and handling high-volume administration support. The ideal...
-
Claims Support Officer
2 weeks ago
Brisbane, Queensland, Australia Procare Group Full timeWe value our supportive and collaborative culture- We offer a thorough, comprehensive induction and ongoing training- Join a leading national provider of insurance risk and solutions servicesFrom a family-started company to an ever-growing national business of over 20 years, we're committed to being the most respected national insurance risk and solutions...
-
Claims Officers
3 weeks ago
Brisbane, Queensland, Australia Troocoo Full timeJoin to apply for the Claims Officers role at Troocoo.Get AI-powered advice on this job and more exclusive features.Queenslanders are no strangers to extreme weather, and RACQ is stepping up to support communities affected by storms and floods. If you're passionate about helping others and want to make a real impact, now is your chance to join RACQ's...
-
Claims Officers
3 weeks ago
Brisbane, Queensland, Australia Troocoo Full timeJoin to apply for the Claims Officers role at Troocoo.Get AI-powered advice on this job and more exclusive features.Queenslanders are no strangers to extreme weather, and RACQ is stepping up to support communities affected by storms and floods. If you're passionate about helping others and want to make a real impact, now is your chance to join RACQ's...
-
Claims Officer
2 weeks ago
Brisbane, Queensland, Australia Qbe Insurance Group Limited Full timeClaims Officer**Primary Details**Time Type: Full timeWorker Type: EmployeeDeliver superior claims service to customers in the Casualty and Specialty classes. Execute superior claims management including determining policy coverage, investigating, evaluating and negotiating claims, and engaging with specialist suppliers and stakeholders.**Claims Officer - QLD...
-
Claims Support Officer
2 weeks ago
Brisbane, Queensland, Australia Gallagher Full time**Introduction**: Join our growing team of dedicated professionals at Gallagher Bassett, who guide those in need to the best possible outcomes for their health and wellbeing. You'll be part of a resilient team that works together to redefine the boundaries of excellence. At our organization, we value collaboration and making a positive impact in the lives of...
-
Claims Officer
7 days ago
Brisbane, Queensland, Australia Austbrokers Comsure Full time $60,000 - $90,000 per yearAbout the role We are seeking a driven and detail-oriented Claims Officer to join our dynamic team at Austbrokers Comsure in Brisbane. In this full-time position, you will play a crucial role in processing and managing insurance claims, ensuring our clients receive prompt and efficient service. With a focus on providing exceptional customer experience, this...
