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 activities
Assess claims decisions against established policies, procedures, regulatory requirements, and quality standards
Identify trends, root causes, and opportunities for process improvement through audit findings and quality analysis
Prepare clear, concise, and actionable audit reports and recommendations
Provide quality feedback to claims examiners and contribute to performance scorecards and coaching initiatives
Review and interpret medical records, coding standards, reimbursement guidelines, and health plan requirements
Validate claims documentation and identify inconsistencies, anomalies, or potential fraud and abuse indicators
Support regulatory audit requirements and ensure compliance with internal and external standards
Produce monthly reporting and insights on quality performance, findings, and improvement opportunities
Collaborate with stakeholders to implement corrective actions and enhance operational effectiveness
Contribute 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 insurance
- Medical claims
- Third Party Administration (TPA)
- Clinical or paramedical environments
- Quality assurance or audit functions
Strong understanding of medical claims processes and adjudication practices
Experience identifying claim variances, errors, and quality issues
Excellent analytical and problem-solving skills
Strong written communication and reporting capability
High attention to detail and the ability to work independently
Proficiency in Microsoft Office and digital systems

Desirable

Bachelor's degree in a Medical, Paramedical, Finance, Business Administration, Insurance, or related discipline
Knowledge of:
- ICD-9 / ICD-10
- CPT
- HCPCS
- UB Billing Codes
Experience auditing healthcare providers, payers, or medical records
Exposure to fraud detection, compliance reviews, or risk management activities
Experience using data, reporting tools, or digital technologies to support quality outcomes

Why join us?

Hybrid working arrangements
Career growth within a global and evolving organisation
Opportunity to work in a highly specialised healthcare and insurance environment
Collaborative and supportive team culture
Exposure to quality improvement, operational excellence, and emerging digital capabilities
The 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.

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.

1 Job for Fraud Detection in Australia

Claims and Quality Support Officer