Quality and Assurance Officer - TPA Health Claims - Allianz - Agios Dimitrios

Job description

Job Summary

We are seeking a detail-oriented and analytical Quality & Assurance officer to join our Health Claims Department. The role is responsible for performing claims audits (including OFR & CFR), handling complaints review and resolution, monitoring operational quality, and preparing management reports to ensure compliance, accuracy, efficiency, and continuous improvement in claims processing.

The position plays a key role in safeguarding service quality, regulatory compliance, and client satisfaction in a TPA environment.

Key Responsibilities

1. Claims quality audits (OFR / CFR)

Perform OFR and CFR on processed claims.
Audit claims files to ensure:
- Compliance with procedures, SLAs, and internal policies
- Accuracy of decisions, documentation, and calculations
- Proper application of benefits, rules, and approvals
Identify errors, deviations, root causes, and process weaknesses.
Document audit findings and follow up on corrective actions.

2. Complaints review & resolution oversight

Review customer complaints related to claims handling and service quality.
Investigate cases to:

Identify root causes
Verify compliance with procedures and contracts
Ensure fair and consistent resolution

Track complaint trends and propose preventive actions and process improvements.

3. Quality monitoring & process improvement

Monitor overall claims quality performance and adherence to KPIs and SLAs.
Contribute to:

Process improvement initiatives
Update of procedures and quality standards
Training needs identification based on audit findings

Support continuous improvement culture within the claims operation.

4. Reporting & management information

Prepare and deliver regular quality reports to management, including:

Audit results (OFR, CFR)
Error rates and trends
Complaints analysis
Root cause analysis and recommendations

Present findings, insights, and improvement proposals in a clear and structured manner.

5. Compliance & governance support

Support compliance with:

Internal policies and procedures
Client SLAs
Regulatory and contractual requirements

Participate in internal and external audits when required.

Qualifications & experience

University degree in Business Administration, Finance, Health Management, or related field.
Experience in one or more of the following is strongly preferred:
- TPA or insurance claims operations
- Quality assurance / quality control
- Internal audit or operational audit
Good understanding of:
- Health insurance / medical claims processes
- Claims workflows and service quality standards
Experience with OFR, CFR, or similar audit frameworks is a strong advantage.

Skills & competencies

Strong analytical and auditing skills.
High attention to detail and accuracy.
Ability to interpret procedures, contracts, and SLAs.
Strong reporting and presentation skills.
Good written and verbal communication in English and Greek.
Objective, structured, and solution-oriented mindset.
Good command of MS Excel and reporting tools.
Ability to work independently and manage multiple tasks and deadlines.
AI Skills: (Generative) Artificial Intelligence or GenAI or AI, Data Analysis, (Microsoft) Copilot, ChatGPT

Offers “Allianz”

Job description