Claims Quality & Support Officer

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 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 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.
• Creates clear and accurate audit findings and recommendation in written audit processing status codes that provides feedback to examiners used in examiner score card, identifies error trends and training opportunity.
• Understands, interprets, and applies coding and reimbursement guideline; 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 are unique and have unique needs, 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 key priority for us. This is why we build Work Well programs to providing you with peace of mind and give the flexibility in planning and arranging for a better work-life balance.

67541 | Customer Services & Claims | Professional | Non-Executive | Allianz Partners | Full-Time | Permanent

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