Quality Assurance Specialist

21 hours ago

Brisbane, Queensland, Australia beBeeClaims Full time $75,000 - $105,000
Job Role

This position is focused on the review and inspection of operational claim processes to ensure quality standards are met. It involves creating clear and accurate audit findings and recommendations in written reports that provide feedback to examiners.

The role requires understanding, interpreting, and applying coding and reimbursement guidelines as well as provider and health plan contracts for professional claims. This includes auditing, assessing, and monitoring providers and payers, including physicians, medical records, and independently codes and abstracts.

Analyzing 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 is also essential. Additionally, verifying and validating claims documents received through multiple channels to rule out documentation / coding errors or inconsistencies that may occur in case of suspected fraud and abuse cases.

Responsibilities
  • Conduct thorough reviews of claim processes to identify areas for improvement.
  • Create detailed reports outlining audit findings and recommendations.
  • Collaborate with examiners to provide feedback and guidance on claim processing.
  • Analyze complex medical data to identify trends and patterns.
Requirements
  • Bachelor's degree in a 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.
  • Proficiency in MS Office and general internet navigation and research skills.
  • Legally permitted to work in the country of operations.
  • Hybrid working option available as per business requirements.
Benefits

Allianz Group values diversity and inclusion and is an equal opportunity employer. We welcome applications from individuals with diverse backgrounds and experiences.

We offer a hybrid working option and opportunities for professional growth and development.

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