Key responsibilities / What you do:

• Responsible for activities concerned with review and inspection to apply quality standards for operational claim processes and adjudication.
• Creates clear and accurate audit findings and recommendations in written audit processing status codes that provide feedback to examiners used in examiner score card, identifies error trends and training opportunities.
• Understands, interprets, and applies coding and reimbursement guidelines; provider and health plan contracts for professional claims to ensure accuracy.
• Audit, assess, and monitor providers and payers, including 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 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.
• Verify and validate claims documents received through multiple channels to rule out the possibility of documentation/coding errors or other inconsistencies that may occur in case of suspected fraud and abuse cases.
• Prepare concise documentation and audit reports, including recommendations to claims management for improvements with corrective action plans.
• Special focus and priority will be given to regulatory audit requirements, reports, and findings.
• A summary of findings will be issued on a monthly basis through a report, including recommendations on changes to be made, aligned with the Claims Quality Manager.
• Other ad hoc duties as required.

AI readiness: Work effectively in an environment shaped by artificial intelligence (AI), machine learning, data analytics, and cloud-based tools, using insights responsibly with our standards of data governance, security, and ethical use.

Key requirements / What you bring:

• Bachelor’s degree in any medical field, paramedical, or a related field preferred.
• 3-5 years’ experience in a customer-focused environment, ideally in clinical, paramedical roles or TPA or insurance roles.
• Demonstrated understanding of medical claims processes and procedures, and ability to recognize and interpret variances.
• Proficiency in MS Office and general internet navigation and research skills.
• Must be detail oriented and have the ability to work independently.
• Legally permitted to work in the country of operations.
• Hybrid working option available as per business requirements.

How we hire

We do not accept unsolicited CVs or approaches from agencies. We only work with partners on our approved supplier list, under contract. Any unsolicited submission will not be considered.

Key benefits / What we offer:

Our employees play an integral part in our success as a business. We appreciate that each of our employees is unique and has unique needs and ambitions, and we enjoy being a part of their journey.

We are there to empower and encourage you with your personal and professional development, ensuring that you take control by offering a large variety of courses and targeted development programs. All that in a global environment where international mobility and career progression are encouraged.

Caring for your health and wellbeing is a key priority for us. This is why we build Work Well programs to provide you with peace of mind and give the flexibility in planning and arranging for a better work-life balance.

Our group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams, and challenges is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow, and to shape a better future for our customers and the world around us.

We stand for unity: we believe that a united world is a more prosperous world, and we are dedicated to consistently advocating for equal opportunities for all. The foundation for this is our inclusive workplace, where people and performance both matter, and nurtures a culture grounded in integrity, fairness, inclusion, and trust.

We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristics protected under applicable local laws and regulations.

About AI at our company:

AI is revolutionizing customer service and claims management through innovative solutions. These AI-driven tools enhance productivity by streamlining complex claims processes, reducing administrative burdens, and accelerating resolution times. Our AI-powered technology has made claims processing faster, offering quicker resolutions, all while ensuring human oversight for claims to maintain service integrity.

By embracing AI and emerging technologies, we continue to lead the industry, meeting ever-changing customer needs with innovative solutions. Our commitment to ethical AI practices safeguards data integrity and trust, ensuring responsible deployment across all operations. This approach not only enhances customer experiences but also supports strategic initiatives like fraud detection and personalized product offerings, solidifying our position as a leader in the insurance sector.

Great to have you on board. Let's care for tomorrow.