We are Allianz Partners. The leader in assistance and insurance solutions in the areas of international health, assistance, automotive and travel insurance. Allianz Partners is a global family of over 19,000 employees across 78 countries. This role is in the International Health part of the business, which has a number of well-known customer facing brands such as Allianz Care, Nextcare and Medi24.
The International Health line of business provides international health, life and disability insurance and services, reinsurance and administration services to a wide range of customers. These include multinational companies, intergovernmental organisations (IGOs), non-governmental organisations (NGOs), private individuals, families and students. Our mission is to ensure that customers have access to quality healthcare through our support, care and commitment to go the extra mile. We are a truly global health partner for our customers, ensuring fast and simple access to the best advice, treatment and value for our customers.
Summary:
The Quality Assurance Specialist – Review & Evaluation is responsible for activities concerned with review and inspection to apply quality standards for operational processes.
Main Responsibilities:
- Prepare concise documentation and audit reports, including recommendations to claims management for improvements with corrective action plans;
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.
Minimum Requirements:
•Bachelors Degree (Nursing or MBBS)
•Minimum 3 years’ experience from Providers in processing/adjusting claims (e.g. ICD-9/10, CPT, HCPC)
•Demonstrated understanding of medical claims processes and procedures, and ability to recognize and interpret variances
•Legally permitted to work in the country of operations.
•Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills
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