Claims Management Processing Officer

Job Overview:

The Claims Management – Processor, evaluate more complex data entry, clerical, and accounting tasks involved in the preparation and processing of patient insurance claims. Supervises releasing team with regards to productivity and efficiency.

What you do:

Responsibilities will include, but are not limited to, the following:

• AI and Coding Standards:

  • Familiarity with AI tools that can automate the coding process, ensuring accuracy and efficiency in applying standards like ICD9, ICD10, CPT, HCPCs, Dental codes, ATC, etc.
  • Understanding of AI algorithms that can analyze and correlate different types of codes (e.g., ICD to CPT correlation) to improve coding practices.

• AI in Fraud Detection:

  • Knowledge of AI systems that can detect patterns of medical claims fraud and abuse practices, such as contra-indication, unbundling, and double billing.
  • Ability to leverage machine learning models to identify anomalies and predict fraudulent activities.

• AI in Auditing:

  • Experience with AI-driven auditing tools that can streamline operations processes and provide real-time insights.
  • Ability to implement AI solutions that enhance the accuracy and efficiency of audits.

• AI in Training and Coaching:

  • Use of AI platforms to develop personalized training programs for operations staff, improving their understanding of coding and fraud detection.
  • Ability to coach staff on using AI tools effectively in their daily tasks.

• AI and Analytical Skills:

  • Proficiency in using AI analytics tools to enhance problem-solving capabilities and derive actionable insights from complex data sets.

• AI in Time Management:

  • Familiarity with AI scheduling and task management tools that optimize time management and workflow efficiency.

• AI in Professional Interaction:

  • Ability to use AI communication tools to enhance interactions with external parties, ensuring clarity and professionalism.

• AI in Confidentiality and Teamwork:

  • Understanding of AI systems that ensure data security and confidentiality while facilitating collaboration in a matrix environment.

• AI in Technical Skills:

  • Proficiency in AI-enhanced MS Office applications that improve productivity and data analysis capabilities.

What you bring:

To be successful in this position you will need to have the following skills/ experience:

• AI in Documentation:

  • Familiarity with AI tools that automate filing and documentation processes, improving accuracy and efficiency.
  • Ability to leverage AI for organizing and retrieving documents quickly.

• AI in Project Management:

  • Use of AI-driven project management tools that provide predictive analytics for revenue forecasting and resource utilization.
  • Understanding of AI systems that enhance project tracking and reporting capabilities.

• AI in Healthcare Industry:

  • Awareness of AI applications in healthcare for improving operational processes and patient data management.
  • Ability to integrate AI solutions to streamline workflows in TPAs, insurance companies, hospitals, and medical centers.

• AI in Technical Skills:

  • Proficiency in AI-enhanced MS Office applications that offer advanced data analysis and visualization features.
  • Use of AI tools for efficient internet navigation and research.

What we offer:

Our employees play an integral part in our success as a business. We appreciate that each of our employees are unique and have unique needs, 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 key priority for us. This is why we build Work Well programs to providing you with peace of mind and give the flexibility in planning and arranging for a better work-life balance

At Allianz Partners, 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, Allianz Partners continues 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 Allianz Partners' position as a leader in the insurance sector.

81258 | Customer Services & Claims | Professional | Non-Executive | Allianz Partners | Full-Time | Permanent