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Claims Quality Specialist

2 months ago

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

We are seeking a highly skilled Claims Quality 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 errors, inconsistencies, and potential fraud.
  • Documentation and Reporting: Prepare detailed documentation and reports on audit findings, including recommendations for improvements and corrective action plans.
  • Provider and Payer Monitoring: Monitor and assess the performance of healthcare providers and payers to ensure compliance with regulatory requirements and industry standards.
  • Coding and Abstracting: Analyze medical records using ICD-9/ICD-10, CPT, HCPCS, and other coding systems to ensure accurate and compliant claims processing.
  • Regulatory Compliance: Ensure that all claims processing activities are in compliance with relevant laws, regulations, and industry standards.
  • Collaboration and Communication: Work closely with claims management, healthcare providers, and other stakeholders to resolve issues and implement improvements.
Requirements
  • Education: Bachelor's Degree in a related field, such as healthcare or business.
  • Experience: Minimum 5 years of experience in medical claims processing, auditing, or a related field.
  • Skills: Strong analytical and problem-solving skills, attention to detail, and excellent communication and interpersonal skills.
  • Certifications: Relevant certifications, such as CPC or CCS, may be required.
About Allianz

Allianz Partners is a leading provider of insurance and asset management services. We are committed to delivering exceptional customer service and creating a positive work environment for our employees. We value diversity and inclusion and are an equal opportunity employer.