Sr. Specialist - Hospital & Claim Audit (Health Insurance)

Allianz
Bangkok
Workplace: OnsiteFull timeFunction: Insurance & ActuarialExperience: 3-5 yearsSkills: []

Ensure Allianz members receive high-quality, appropriate hospital and treatment care aligned with clinical protocols and pricing guidelines. Develop and implement clinical quality strategy, conduct clinical audits across provider and non-provider networks, and review care for high-claim members. Provide analytical feedback to hospitals, clinics, and doctors to improve procedural costs, length of stay, and outcomes, while supporting clinical governance meetings and pool insurance discussions.

Loading

Loading job details...

Preparing the role view and application actions.

FursaFursa
Allianz
Allianz
2 days ago

Sr. Specialist - Hospital & Claim Audit (Health Insurance)

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI
Last checked: 12 hours agoStatus: Live

Job Summary

Ensure Allianz members receive high-quality, appropriate hospital and treatment care aligned with clinical protocols and pricing guidelines. Develop and implement clinical quality strategy, conduct clinical audits across provider and non-provider networks, and review care for high-claim members. Provide analytical feedback to hospitals, clinics, and doctors to improve procedural costs, length of stay, and outcomes, while supporting clinical governance meetings and pool insurance discussions.
Location: Bangkok
Workplace: Onsite
Employment Type: Full time
Job Function: Insurance & Actuarial
Seniority: Mid level

Key Responsibilities

  • •Develop and implement a clinical quality strategy to ensure members receive high-quality, appropriate care
  • •Ensure treatments and hospital admissions follow agreed protocols and are appropriate
  • •Provide analytical feedback to hospitals, clinics, and doctors to improve clinical best practices, procedural costs, length of stays, and outcomes
  • •Conduct clinical audits for provider and non-provider networks, including retrospective internal and external reviews
  • •Review and manage treatment of high-claim members and support clinical governance activities (pool insurance meeting, claim and clinical committee)

Key Requirements

  • •Bachelor’s or master’s degree in Nurse Science
  • •3-5 years of experience as a nurse in hospital and/or insurance industry (advanced level)
  • •Understanding of insurance databases
  • •Experience collecting, evaluating, and interpreting data
  • •Experience with data analysis and visualization tools such as PowerBI or Tableau
Experience:3-5 years
Education:
Tech Stack:PowerBITableauTrelloJIRAAsanaMicrosoft OfficeMicrosoft EPMMS OutlookChatGPTCoPilot365

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