Medical Provider Performance Executive

Role overview

This role focuses on carrying out objective, balanced, thorough, and prompt investigations into healthcare providers involved in fraud, waste, or abuse affecting Allianz Group or its payers. The position also requires maintaining constructive working relationships with all stakeholders while protecting the integrity of the process.

The work calls for initiative, creativity, and the ability to uncover information that is not immediately available. It also requires independent working with limited supervision, strong planning skills to handle a substantial case load, and sound judgment when assessing allegations.

A key part of the job is using analytical thinking to review, interpret, and evaluate information needed to resolve complex and sensitive investigations.

Key responsibilities

• Identify and help prevent fraud, abuse, and waste linked to medical providers across assigned regions or countries.
• Use data mining and data analysis to investigate provider claims.
• Support the savings objectives defined by the Global Head of MPM.
• Review case files, collect supporting information, and gather evidence related to suspicious claims activity.
• Record all findings clearly so that valid claims can be supported, unjustified claims can be denied, inappropriate payments can be recovered, or action can be recommended against responsible parties.
• Take part in onsite audits, in-house claims reviews, and mystery shopping initiatives.
• Assist the Medical Provider Performance Manager with administrative and operational tasks related to fraud detection and prevention.
• Assess each case and decide the most effective investigation method.
• Prepare detailed investigation reports and analytical summaries.
• Work closely with internal teams such as legal, finance, and claims operations, as well as external clients and providers.
• Consult legal and regulatory bodies when cases may lead to legal action.
• Maintain periodic dashboards and reporting outputs.
• Contribute to special projects and procurement-related assignments when needed.
• Help preserve provider relationships in coordination with the MPM team.
• Use discretion, diplomacy, and confidentiality throughout the procurement process while safeguarding process integrity.
• Protect the reputation of the company, beneficiaries, payers, and all other involved parties.
• Work with AI, machine learning, data analytics, and cloud-based tools while following strong standards for data governance, security, and ethical use.

Required profile

• Medical or paramedical educational background.
• Knowledge of medical coding systems, including ICD, CPT, and HCPCS.
• Understanding of claims adjudication, including policies, benefits, exclusions, and payer rules.
• Ability to detect fraud, waste, and abuse patterns such as anomalies, upcoding, and unnecessary care.
• Strong analytical capability for reviewing data, identifying trends, and determining root causes.
• Awareness of applicable regulations and payer compliance requirements.
• High attention to detail for audit review and documentation accuracy.
• Familiarity with audit methods such as sampling, retrospective audits, and concurrent audits.
• Strong communication and negotiation skills for reporting, provider engagement, escalation handling, and coordination.
• Comfort with claims systems, audit tools, Excel, and other data tools.

Additional information

Allianz Group describes itself as one of the world’s most trusted insurance and asset management companies. The organization emphasizes care for employees, customer focus, and a shared mission to shape a better future for customers and the wider world.

The company promotes a culture built on unity, inclusion, integrity, fairness, and trust, and welcomes applicants regardless of race, ethnicity, cultural background, age, gender, nationality, religion, social class, disability, sexual orientation, or any other protected characteristic under local laws and regulations.

Employees are expected to show openness to movement across functions, Allianz entities, and geographies as part of a broader culture of rotation and experience-building.