Claims Retrospective Officer

ResponsibilitiesResponsible for the clinical assessment of medical claims to ensure compliance with medical necessity, policy coverage, and clinical guidelines.Review inpatient and outpatient medical claims for clinical accuracyValidate diagnoses, procedures, and services against medical records and policy termsIdentify discrepancies, overutilization, or non-compliance with guidelinesCollaborate with claims teams to support adjudication decisionsEnsure decisions are in line with medical policies and regulatory requirementsOther ad hoc duties as requiredKey Requirements / What You BringMedical\Paramedical Degree (MBBS, MD, BS Pharma, PharmaD, BDS, BDent, or equivalent)Minimum 1–3 years of clinical practice or medical review experienceFamiliarity with ICD, CPT, DRG coding, and insurance guidelinesStrong analytical and decision-making skillsHigh level of accuracy and attention to detailProficiency in medical review systems and documentation toolsExcellent written and verbal communication in EnglishFlexibility to adapt to changing business needs and work under pressureLegally permitted to work in the country of operationsHybrid working option available as per business requirementsCompany Overview & CommitmentAllianz Partners employs AI to revolutionize 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.Allianz 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.At Allianz, 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. And 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.Great to have you on board. Let\'s care for tomorrow.Note: Having different strengths, experiences, perspectives and approaches is an integral part of Allianz’s company culture. One means to achieve this is a regular rotation of Allianz Executive employees across functions, Allianz entities and geographies. Therefore, the company expects from its employees a general openness and a high motivation to regularly change positions and collect experiences across Allianz Group.#J-18808-Ljbffr