Claims Retrospective Associate - Fluent English (Physicians only)

About the role

The Claims Retrospective Associate combines clinical expertise with claims adjudication responsibilities. Working within Allianz Partners in Cairo, the role ensures that inpatient and outpatient medical claims are assessed accurately, comply with policy terms, and follow clinical guidelines while delivering high‑quality service in a fast‑paced environment.

Key responsibilities

• Conduct clinical assessments of medical claims to verify accuracy and policy compliance.
• Validate diagnoses, procedures, and services against medical records, ICD, CPT and DRG codes.
• Identify discrepancies, over‑utilisation, or non‑compliance with clinical guidelines.
• Collaborate with claims teams to support adjudication decisions and ensure alignment with regulatory requirements.
• Maintain accurate workload data in the client database for effective planning.
• Respond professionally to customer inquiries and coordinate with other departments to achieve satisfaction.
• Participate in departmental medical training to enhance terminology and claims‑processing knowledge.
• Contribute to productivity targets and service level agreements.
• Perform ad‑hoc duties as required.

Required profile

• Bachelor of Medicine and Surgery (Physician) – Internal Medicine or Physical Therapy specialization.
• 1–3 years of clinical practice or medical review experience.
• Legal permission to work in Egypt.
• Excellent written and verbal communication skills in English.
• Ability to adapt to changing business needs and work under pressure.

Required skills

• Familiarity with ICD, CPT and DRG coding systems.
• Knowledge of insurance guidelines and medical review processes.
• Proficiency in medical review systems and documentation tools.
• Strong analytical and decision‑making abilities with high attention to detail.
• Competence in MS Office applications.