Full job description
Allianz Partners. Allianz Partners is the leader in international assistance and insurance solutions. Allianz Partners is a worldwide family with over 19,000 employees in 78 countries. This is the International Health division of the company, which includes a variety of well-known brands like Allianz Care and Nexcare.
International Health is a business that provides international life, disability, and health insurance services. It also offers reinsurance and administration services for a broad range of customers. Multinational companies, non-governmental organizations (NGOs), private individuals, families, and students are all examples. Our goal is to make sure that our customers have access to quality healthcare by providing support, care, and a commitment to going the extra mile. Our customers have a true global partner in their health care, and we make sure they get the best advice, treatment, and value.
Summary:
The Quality Assurance Specialist – Review & Evaluation is responsible to review and inspect operational processes in order to establish quality standards.
- Prepare concise documentation and audit reports. Include recommendations to claims management regarding improvements and corrective actions.
Audit, assess and monitor payers and providers, including physicians, inpatients, outpatients, ancillary, behavioral health, laboratory, and others. medical records, as well as independently codes and abstracts.
- Analyze inpatient and outpatient medical records using the 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.
- To rule out any documentation/coding errors, or inconsistencies that might occur in suspected fraud and abuse cases, verify and validate all claims documents.
- Bachelor's Degree in Nursing or MBBS
- Minimum three years experience in processing/adjusting claims from providers (e.g. ICD-9/10, CPT, HCPC)
- Demonstrable understanding of medical claims procedures and processes, as well as the ability to recognize and interpret deviations
- It is legal to work in the country where you are operating. Fluency in MS Office (Excel Word, Outlook PowerPoint, Word) and general internet navigation skills and research skills
