Claims Quality & Support Officer

Job description

JOB DETAILS / ROLE PURPOSE

The Quality Officer plans, coordinates, and implements quality management and quality control programs for the Operations Department.  The position is responsible to completely control the quality measures as set out by the company and ensure adequate control measures and improvement systems are designed and implemented to achieve the company goals.

 

Key responsibilities/What you do:

Personal Accountabilities:

·  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.
·  Provide quality follow through and excellence in service in all dealings with customers and client companies.

Financial Accountabilities

·  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.
·  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.
·  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 monthly basis through a report, including recommendations on changes to be made, aligned with the Claims Quality Manager
·   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.

Culture:

·  Our culture underpins who we are as an organisation, how we do business and how we interact with the wider community.
·  As a quality officer within this business, you must continue to act as a role model with the below values underpinning your decision and actions

 

Key requirements/What you bring

·  3+ years of experience in a customer-focused environment, ideally in clinical, paramedical, TPA, or insurance roles.
·  Proficiency in MS Office and internet research is essential.
·  Problem-Solving & Decision-Making: Strong decision-making skills, knowledge of medical claims processes, attention to detail, and the ability to work independently while delivering superior customer service.
·  Communication Skills: Ability to influence and build relationships across all levels, adapt communication styles to different audiences, and demonstrate strong written and verbal communication.
·  Professionalism & Work Ethic: A high level of professionalism, ability to perform under pressure, strong organizational skills, and a professional presentation.
·  Teamwork & Independence: Capable of working both autonomously and collaboratively, supporting team members, assisting leadership, and contributing to key performance goals

 

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

63354 | Customer Services & Claims | Professional | Non-Executive | Allianz Partners | Full-Time | Permanent

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. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow and to shape a better future for our customers and the world around us. 
We at Allianz believe in a diverse and inclusive workforce and are proud to be an equal opportunity employer. We encourage you to bring your whole self to work, no matter where you are from, what you look like, who you love or what you believe in.
We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, disability or sexual orientation.
Join us. Let's care for tomorrow.