Claims Retrospective Associate Fluent English (phy

Job Summary

Location: Cairo Egypt

Role Purpose: The Claims Retrospctive Officer is responsible for the clinical assessment and adjudication of medical claims ensuring compliance with medical necessity policy coverage and clinical guidelines. This role combines the expertise of a physician with the operational duties of a claims officer to deliver high-quality service and decision-making in a fast-paced environment.

Key Responsibilities / What you do:

Conduct clinical assessments of inpatient and outpatient medical claims to ensure accuracy and compliance with policy terms and clinical guidelines.

Validate diagnoses procedures and services against medical records and policy terms.

Identify discrepancies overutilization or non-compliance with guidelines.

Collaborate with claims teams to support adjudication decisions and ensure alignment with medical policies and regulatory requirements.

Utilize AWCs client database accurately to reflect departmental workload and facilitate effective target planning.

Respond to customer inquiries professionally and liaise with other departments to ensure efficient and professional responses achieving customer satisfaction.

Participate in departmental medical training to expand knowledge of medical terminology and procedures and develop comprehensive claims processing skills.

Contribute to team and departmental productivity targets to achieve agreed SLA and provide high-level customer service.

Other ad hoc duties as required.

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.

Key Requirements / What you bring:

Bachelor of Medicine and Surgery Physician Internal Medicine or Physical Therapy only

Minimum 13 years of clinical practice or medical review experience.

Familiarity with ICD CPT DRG coding and insurance guidelines.

Strong analytical and decision-making skills with high accuracy and attention to detail.

Proficiency in medical review systems documentation tools and MS Office.

Excellent written and verbal communication skills in English.

Flexibility to adapt to changing business needs and work under pressure.

Legally permitted to work in the country of operations.

Hybrid working option available as per business requirements.

How we hire

Agency StatementAllianz Partners does 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

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. Lets care for tomorrow.

Required Experience:

IC

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