A

AXA

Global insurer offering life, property, casualty

Sachbearbeiter Leistungsprüfung - DRG/PEPP

Claims AdjudicationPosted on Nov 9
Full-timeCologne, Germany

About the Job

Requirements

  • Completed vocational training as a nursing professional or registered nurse, or a nursing-related degree such as Nursing or Nursing Science (B.Sc.).
  • Clinical experience in psychiatry or psychosomatics.
  • Knowledge of PEPP/DRG billing fundamentals and review tools, for example from medical controlling, health insurance or the Medical Service.
  • Ability to make persuasive professional arguments and communicate appropriately with medical and nonmedical interlocutors, remaining objective and constructive when viewpoints differ.
  • Ability to recognize patterns in medical cases, distinguish standard cases from exceptions and organize complex relationships systematically.
  • Ability to learn new billing and coding rules, question previous assumptions and apply learning to unfamiliar cases.
  • Openness to other professional perspectives and willingness to both offer and accept support in challenging cases.

Responsibilities

  • Review inpatient invoices focused on psychiatry and psychosomatics for medical plausibility, correct diagnosis and procedure coding, and compliance with applicable billing rules, particularly DRG/PEPP.
  • Compare invoices with the tariff-covered services, account for benefit limits at private clinics and, when needed, calculate insured members' expected out-of-pocket costs from estimates.
  • Clarify queries and objections with clinics and explain review results clearly and in a customer-oriented manner to billers, intermediaries and insured members, in writing and by telephone.
  • Contribute to developing review rules and provide professional requirements for adapting review tools.
  • Contribute experience from medical practice or invoice review to projects within and across teams.
  • Deepen billing expertise through regular training and discuss review cases and changes to the DRG/PEPP systems with the team.

Desired Qualifications

  • Practical coding experience with ICD-10-GM and OPS using the German Coding Guidelines (DKR/DKR-Psych).

About the Company

AXA

Global insurer offering life, property, casualty

AXA is a global insurer and asset manager that provides life, health, and property and casualty insurance, as well as related financial services. Its products work by customers paying insurance premiums in exchange for coverage against risks; AXA pools risk across many policyholders, prices premiums based on risk, and pays claims when events occur, while also offering investment and retirement products through its asset management arm. The company has grown through large acquisitions, giving it a wide geographic footprint and a diverse mix of personal, commercial, and specialty insurance offerings. This scale and breadth set AXA apart from many competitors, alongside a long history of strategic mergers that expanded its reach to customers around the world. AXA’s goal is to be a leading global insurer and asset manager, delivering financial protection and long-term value to customers and stakeholders.

Company size
10,001+
Company stage
IPO
Headquarters
Paris, France
Founded
1816

Recently Posted Jobs

Explore more opportunities at AXA

See more jobs