Claims Retrospective Associate F/M (Tunis, TN)

Allianz
Tunis
Workplace: OnsiteFull timeFunction: Insurance & ActuarialExperience: 1-2 yearsEducation: bachelorsSkills: ["Analytical skills","Attention to detail","Communication","Teamwork","Ownership"]

Review high-cost reimbursement and direct medical claims to ensure they’re assessed correctly, fairly, and within service levels. Investigate coverage against policy terms, manage medical evaluations, and identify errors, inconsistencies, or potential fraud. Respond to claims processor questions and coordinate with internal teams to resolve issues and maintain accurate, audit-ready documentation. Work with AI, machine learning, and analytics tools while following data governance, security, and ethical-use standards.

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FursaFursa
Allianz
Allianz
23 hours ago

Claims Retrospective Associate F/M (Tunis, TN)

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Source: Company careers pageValidated by: Fursa AI
Last checked: 9 hours agoStatus: Live

Job Summary

Review high-cost reimbursement and direct medical claims to ensure they’re assessed correctly, fairly, and within service levels. Investigate coverage against policy terms, manage medical evaluations, and identify errors, inconsistencies, or potential fraud. Respond to claims processor questions and coordinate with internal teams to resolve issues and maintain accurate, audit-ready documentation. Work with AI, machine learning, and analytics tools while following data governance, security, and ethical-use standards.
Location: Tunis
Workplace: Onsite
Employment Type: Full time · Permanent
Job Function: Insurance & Actuarial
Seniority: Entry level

Key Responsibilities

  • •Review and handle high-cost reimbursement and direct medical claims in line with procedures, policy coverage, and medical guidelines.
  • •Answer queries from claims processors and clarify coverage or medical aspects to help resolve issues impacting turnaround time or quality.
  • •Support team and department productivity targets to meet SLAs while maintaining quality and customer focus.
  • •Maintain accurate, up-to-date claims decision records and documentation supporting audit and compliance requirements.
  • •Identify potential fraud, inconsistencies, or errors and escalate or act according to internal risk guidelines, improving claims processes with risk/quality teams.

Key Requirements

  • •Bachelor’s degree in a medical, paramedical, or related field with the ability to interpret medical reports and terminology.
  • •1–2 years of experience in clinical, paramedical, TPA, insurance, or similar customer-facing environments handling sensitive information.
  • •Familiarity with insurance policies, claims procedures, and regulatory requirements to apply coverage rules to real claim scenarios.
  • •Strong analytical and detail-oriented skills to spot discrepancies and make balanced decisions using data and documentation.
  • •Ability to communicate decisions clearly and collaborate with colleagues when claims issues require joint resolution.
Experience:1-2 yearsMedical insuranceClinicalTPACustomer-facingInsurance
Education:Bachelor's in medical, paramedical, or related field
Skills:Analytical skillsAttention to detailCommunicationTeamworkOwnership
Tech Stack:MS OfficeAIMachine learningData analyticsCloud-based tools

Eligibility

Work Authorization:Authorization required. Sponsorship not provided.

Company Brief

Allianz
Global insurance and financial services group offering property-casualty insurance, life and health insurance, asset management, and corporate risk solutions to individuals, businesses, and institutions across more than 70 countries.
Industry: Insurance
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: Munich, Germany
Founded: 1890
WebsiteLinkedIn