Claims Quality Assurance Specialist

7 days ago


Dubai, Dubai, United Arab Emirates Allianz Full time
Job Summary

We are seeking a highly skilled Claims Quality Assurance Specialist to join our team at Allianz Partners. The successful candidate will be responsible for ensuring the quality and accuracy of medical claims processes and procedures.

Key Responsibilities
  • Claims Review and Audit: Conduct thorough reviews and audits of medical claims to identify any errors or inconsistencies.
  • Documentation and Reporting: Prepare concise documentation and reports, including recommendations for improvements and corrective action plans.
  • Provider and Payer Monitoring: Audit and assess providers and payers to ensure compliance with regulatory requirements and contractual agreements.
  • Coding and Abstracting: Analyze medical records using ICD-9/ICD-10, CPT, HCPCS, and other codes to ensure accurate coding and abstracting.
  • Fraud and Abuse Detection: Verify and validate claims documents to detect any potential fraud or abuse.
  • Regulatory Compliance: Ensure compliance with regulatory requirements and contractual agreements.
  • Reporting and Recommendations: Provide regular reports and recommendations to the Claims Quality Manager on areas for improvement.
Requirements
  • Education: Bachelor's Degree in a related field, such as Medical Degree or Nursing.
  • Experience: Minimum 5 years' experience in processing or adjusting claims, or minimum 3 years' experience in auditing.
  • Skills: Demonstrated understanding of medical claims processes and procedures, ability to recognize and interpret variances, and fluency in MS Office.


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