Claims Retrospective Officer

Job description

Key Responsibilities/ What you do:

•Responsible for the clinical assessment of medical claims to ensure compliance with medical necessity, policy coverage, and clinical guidelines.
• Review inpatient and outpatient medical claims for clinical accuracy
• Validate diagnoses, procedures, and services against medical records and policy terms
• Identify discrepancies, overutilization, or non-compliance with guidelines
• Collaborate with claims teams to support adjudication decisions
• Ensure decisions are in line with medical policies and regulatory requirements
• Other Ad hoc duties as required


Key Requirements/ What you bring:

• Medical\Paramedical Degree (MBBS, MD, BS Pharma, PharmaD, BDS, BDent, or equivalent)
• Minimum 1–3 years of clinical practice or medical review experience
• Familiarity with ICD, CPT, DRG coding, and insurance guidelines
• Strong analytical and decision-making skills
• High level of accuracy and attention to detail.
• Proficiency in medical review systems and documentation tools
• Excellent written and verbal communication in English
• Flexibility to adapt to changing business needs and work under pressure.
• Legally permitted to work in the country of operations.
• Hybrid working option available as per business requirements.

At Allianz Partners, AI is revolutionizing customer service and claims management through innovative solutions. These AI-driven tools enhance productivity by streamlining complex claims processes, reducing administrative burdens, and accelerating resolution times. Our AI-powered technology has made claims processing faster, offering quicker resolutions. All while ensuring human oversight for claims to maintain service integrity. By embracing AI and Emerging Technologies, Allianz Partners continues to lead the industry, meeting ever-changing customer needs with innovative solutions. Our commitment to Ethical AI practices safeguards data integrity and trust, ensuring responsible deployment across all operations. This approach not only enhances customer experiences but also supports strategic initiatives like fraud detection and personalized product offerings, solidifying Allianz Partners' position as a leader in the insurance sector.