Claims and Quality Support Officer (Adelaide, SA, AU, 5000)

Allianz
Adelaide
Workplace: HybridContractFunction: Quality & Regulatory (Non-Software)Experience: 3-5 yearsSkills: ["Analytical thinking","Problem-solving","Written communication","Attention to detail","Independent work"]

Audit and review medical claims processing and adjudication to ensure accuracy, consistency, and regulatory compliance. Identify trends, root causes, and process improvement opportunities through quality analysis, and produce clear audit reports and recommendations. Provide quality feedback to claims examiners, support performance scorecards and coaching, and validate medical records, coding standards, and reimbursement guidelines. Contribute to corrective actions and smarter workflows as the business evolves digitally.

Loading

Loading job details...

Preparing the role view and application actions.

FursaFursa
Allianz
Allianz
3 hours ago

Claims and Quality Support Officer (Adelaide, SA, AU, 5000)

✓ Verified Job

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

Source: Company careers pageValidated by: Fursa AI
Last checked: 3 hours agoStatus: Live

Job Summary

Audit and review medical claims processing and adjudication to ensure accuracy, consistency, and regulatory compliance. Identify trends, root causes, and process improvement opportunities through quality analysis, and produce clear audit reports and recommendations. Provide quality feedback to claims examiners, support performance scorecards and coaching, and validate medical records, coding standards, and reimbursement guidelines. Contribute to corrective actions and smarter workflows as the business evolves digitally.
Location: Adelaide
Workplace: Hybrid
Employment Type: Contract · Permanent
Job Function: Quality & Regulatory (Non-Software)
Seniority: Mid level

Key Responsibilities

  • •Conduct quality reviews and audits on medical claims processing and adjudication activities.
  • •Assess claims decisions against policies, procedures, regulatory requirements, and quality standards.
  • •Identify trends and root causes and recommend process improvements based on audit findings and quality analysis.
  • •Prepare clear audit reports and actionable recommendations; provide quality feedback to claims examiners.
  • •Support regulatory audit requirements, validate documentation/coding standards, and produce monthly quality performance reporting and insights.

Pay and Benefits

Perks:Hybrid Working

Key Requirements

  • •3-5 years' experience in a customer-focused environment, ideally within health insurance, medical claims, Third Party Administration (TPA), clinical/paramedical environments, or quality assurance/audit functions.
  • •Strong understanding of medical claims processes and adjudication practices, including identifying claim variances, errors, and quality issues.
  • •Excellent analytical and problem-solving skills with strong written communication and reporting capability.
  • •High attention to detail and ability to work independently.
  • •Proficiency in Microsoft Office and digital systems.
Experience:3-5 yearsHealth insuranceMedical claimsTPAHealthcare
Skills:Analytical thinkingProblem-solvingWritten communicationAttention to detailIndependent work
Tech Stack:Microsoft OfficeDigital systemsICD-9ICD-10CPTHCPCSUB Billing Codes

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