Claims Retrospective Associate F/M

This role exists to make sure that complex, high‑cost medical claims are assessed correctly, fairly, and on time.

You’ll be the person who looks at reimbursement and direct claims in detail, checks coverage against policy terms, manages medical evaluations, spots errors or inconsistencies, and helps keep turnaround times within agreed service levels. You’ll also be a go‑to contact for claims processors when they have questions.

This role is for someone with a medical or paramedical background who is comfortable working with data, policies and procedures, and who enjoys combining clinical understanding with careful, structured analysis. If you like digging into the detail of medical claims, making sound judgments, and supporting others to get to the right outcome, you’re likely a good fit. 

What you do

You will spend most of your time:

• Reviewing and handling high‑cost reimbursement and direct medical claims in line with established procedures, policy coverage, and medical guidelines
• Answering queries from claims processors, clarifying coverage or medical aspects of a claim, and helping resolve issues that affect turnaround time or quality
• Supporting team and department productivity targets, helping the function meet Service Level Agreements (SLAs) while maintaining quality and customer focus
• Providing clear, accurate responses to client and internal inquiries, and collaborating with other departments when needed to resolve claims‑related issues
• Maintaining accurate, up‑to‑date records of claims decisions and activities, ensuring documentation supports audit and compliance requirements
• Identifying potential fraud, inconsistencies, or errors within claims and escalating or acting in line with internal procedures and risk guidelines
• Working with risk management and quality teams to improve claims processes and support robust quality control measures
• Work effectively in an environment shaped by artificial intelligence (AI), machine learning, data analytics and cloud-based tools, using insight responsibly and in line with our standards for data governance, security and ethical use
• Handling other ad hoc tasks related to claims as business needs arise

What you bring

We’re looking for:

• Relevant medical background – Bachelor’s degree in a medical, paramedical, or related field. You can understand medical reports, terminology, and treatment plans well enough to assess claims logically and consistently.
• Experience in medical/insurance or customer‑focused environments – Around 1–2 years in clinical, paramedical, TPA, insurance, or similar customer‑facing roles. You’re used to handling sensitive information and making decisions that affect patients or customers.
• Claims and insurance know‑how – Familiarity with insurance policies, claims procedures, and regulatory requirements. You can apply rules and coverage conditions to real‑life claim scenarios.
• Strong analytical skills and attention to detail – You’re comfortable working through complex cases, spotting discrepancies, and making balanced decisions based on data, documentation, and policy terms.
• Effective communication skills – You can explain decisions clearly to colleagues and clients, handle queries professionally, and collaborate across teams when issues need joint resolution.
• Comfort with tools and technology – Proficiency in MS Office and claims management or data analysis tools. You can learn new systems quickly and use them to document, track, and analyse claims.
• Teamwork and ownership – Able to work independently on your own portfolio of claims while contributing to team targets and supporting colleagues when they need input.
• Right to work – Legally permitted to work in the country of operations; hybrid working may be available depending on business requirements.

How we hire

We hire directly. Allianz Partners does not accept unsolicited CVs or approaches from agencies. We only work with partners on our approved supplier list, under contract. Any unsolicited submissions will not be considered.

106749 | Physicians | Professional | Non-Executive | Allianz Partners | Full-Time | Permanent

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.