Claims and Quality Support Officer

Claims Quality & Support Officer

Employment Type: Full Time Maternity Leave contract

Join a team where quality, accuracy and innovation matter

We're looking for a detail-oriented Claims Quality & Support Officer to help drive excellence across our health and medical claims operations. In this role, you'll be responsible for auditing claims decisions, identifying process improvements, ensuring regulatory compliance, and supporting a culture of continuous learning and operational excellence.

This is an exciting opportunity for someone with a background in medical claims, health insurance, TPA operations, clinical administration, or medical coding who enjoys combining analytical thinking with quality assurance and process improvement.

As our business continues to evolve through digital transformation and enhanced data-driven decision making, you'll play an important role in helping maintain accuracy, consistency, and quality standards across claims operations.

What you'll be doing

Conduct quality reviews and audits on medical claims processing and adjudication activitiesAssess claims decisions against established policies, procedures, regulatory requirements, and quality standardsIdentify trends, root causes, and opportunities for process improvement through audit findings and quality analysisPrepare clear, concise, and actionable audit reports and recommendationsProvide quality feedback to claims examiners and contribute to performance scorecards and coaching initiativesReview and interpret medical records, coding standards, reimbursement guidelines, and health plan requirementsValidate claims documentation and identify inconsistencies, anomalies, or potential fraud and abuse indicatorsSupport regulatory audit requirements and ensure compliance with internal and external standardsProduce monthly reporting and insights on quality performance, findings, and improvement opportunitiesCollaborate with stakeholders to implement corrective actions and enhance operational effectivenessContribute to initiatives that support smarter workflows, quality optimisation, and continuous process improvement

What you'll bring

Essential

3-5 years' experience in a customer-focused environment, ideally within:
Health insuranceMedical claimsThird Party Administration (TPA)Clinical or paramedical environmentsQuality assurance or audit functions
Strong understanding of medical claims processes and adjudication practicesExperience identifying claim variances, errors, and quality issuesExcellent analytical and problem-solving skillsStrong written communication and reporting capabilityHigh attention to detail and the ability to work independentlyProficiency in Microsoft Office and digital systems

Desirable

Bachelor's degree in a Medical, Paramedical, Finance, Business Administration, Insurance, or related disciplineKnowledge of:
ICD-9 / ICD-10CPTHCPCSUB Billing Codes
Experience auditing healthcare providers, payers, or medical recordsExposure to fraud detection, compliance reviews, or risk management activitiesExperience using data, reporting tools, or digital technologies to support quality outcomes

Why join us?

Hybrid working arrangementsCareer growth within a global and evolving organisationOpportunity to work in a highly specialised healthcare and insurance environmentCollaborative and supportive team cultureExposure to quality improvement, operational excellence, and emerging digital capabilitiesThe chance to make a meaningful impact on customer outcomes and claims quality standards

Ready to apply?

If you're passionate about quality, enjoy working with complex claims information, and thrive in an environment focused on continuous improvement and smarter ways of working, we'd love to hear from you.

Apply now and help shape the future of claims quality and operational excellence.

103358 | Customer Services & Claims | Professional | Non-Executive | Allianz Partners | Full-Time | Temporary

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.