Claims Retrospective Officer

Why This Role Matters
Claims Retrospective Officers play a critical role in ensuring the accuracy, compliance, and efficiency of medical claims processing. By reviewing clinical details against medical policies and regulatory requirements, they help protect the financial and operational integrity of the organization while ensuring fair and timely resolutions for customers. In a hybrid working environment, these professionals also contribute to leveraging AI-driven tools for faster and more reliable claims adjudication.

Job Description
Nextcare Claims Management LLC, part of Allianz Partners, is seeking a Claims Retrospective Officer to join its team in Dubai, United Arab Emirates. This full-time, permanent position combines clinical knowledge with claims management expertise. The role involves reviewing inpatient and outpatient medical claims, validating diagnoses and procedures, ensuring compliance with policy terms, and supporting adjudication decisions. The Claims Retrospective Officer will collaborate with claims teams, use AI-powered review systems, and maintain accurate documentation to uphold high standards of service integrity.

Key Features of the Role
• Position: Claims Retrospective Officer
• Company: Nextcare Claims Management LLC (Allianz Partners)
• Location: Dubai, United Arab Emirates
• Employment Type: Full-Time, Permanent
• Workplace Type: Hybrid (on-site and remote)
• Industry: Insurance / Claims Management
• Candidate Level: Professional

Responsibilities
• Conduct clinical assessment of medical claims to ensure compliance with medical necessity, policy coverage, and clinical guidelines
• Review inpatient and outpatient claims for clinical accuracy
• 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
• Ensure decisions comply with medical policies and regulatory requirements
• Perform other ad hoc duties as required

Required Qualification
• Medical or Paramedical Degree (MBBS, MD, BS Pharma, PharmaD, BDS, BDent, or equivalent)
• Minimum 1–3 years of clinical practice or medical review experience

Important Requirements
• Familiarity with ICD, CPT, DRG coding, and insurance guidelines
• Strong analytical and decision-making skills
• High level of accuracy and attention to detail
• Proficiency in medical review systems and documentation tools
• Excellent written and verbal communication in English
• Flexibility to adapt to changing business needs and work under pressure
• Legally permitted to work in the UAE

Employment Options
• Hybrid working arrangement available as per business requirements

What We Offer
• Competitive salary and benefits
• Access to AI-powered claims management tools
• Modern and supportive work environment
• Opportunities for career growth and professional development
• Exposure to innovative insurance and healthcare solutions
• Inclusive and diverse workplace culture

Experience and Skills
• Clinical assessment and review of medical claims
• Knowledge of insurance and medical coding systems
• Collaboration with multidisciplinary teams
• Attention to detail and high accuracy in documentation
• Adaptability to hybrid work environment and AI-assisted workflows

Salary Insights
• Salary not specified in the posting
• Competitive remuneration with benefits based on experience and qualifications

Company Overview
Nextcare Claims Management LLC, part of Allianz Partners, is a leading provider of insurance claims management services. Allianz Partners leverages AI-driven solutions to enhance claims productivity, ensure compliance, and provide fast, reliable resolutions while maintaining human oversight. The organization is committed to ethical AI practices, employee development, and fostering an inclusive and diverse workplace. Allianz Group is a globally trusted insurance and asset management company dedicated to innovation, integrity, and empowering its employees.

FAQs

1. Is clinical experience required for this role?
   Yes, candidates must have 1–3 years of clinical practice or medical review experience.

2. Does this role involve AI-assisted claims review?
   Yes, the position utilizes AI-driven tools to streamline claims processing.

3. Is hybrid work available?
   Yes, this role offers a combination of on-site and remote work.

4. Are coding and insurance guidelines knowledge required?
   Yes, familiarity with ICD, CPT, DRG coding, and insurance guidelines is essential.

Application Tips
• Highlight clinical and medical review experience
• Demonstrate knowledge of medical coding and insurance guidelines
• Mention experience with claims systems or AI-powered workflows
• Emphasize accuracy, analytical skills, and adaptability
• Include legal eligibility to work in the UAE