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Claims Specialist
1 week ago
Job Overview
Waseel is looking for a Claims Specialist to join our team to work in Riyadh
Key Responsibilities
Review and verify the accuracy of medical claims submitted by healthcare providers, ensuring compliance with company policies, procedures, and regulatory requirements.
- Superior math aptitude and strong analytical ability
- Assess claim eligibility based on insurance policies, coverage plans, and pre-established guidelines.
- Determine coverage limitations, exclusions, and any additional documentation requirements.
- Process medical claims accurately and efficiently using designated software or systems. Input necessary data, codes, and documentation to facilitate timely payment or denial of claims.
- Experience with reserving and pricing techniques if having prior health and general insurance experience.
- Superior math aptitude and strong analytical ability
- Collaborate with healthcare providers, insurance companies, and policyholders to resolve claim-related inquiries, discrepancies
- Ability to work both independently and as part of a team.
Qualifications
- Previous experience in healthcare claims processing or medical billing is highly desirable.
- Familiarity with medical terminology, coding systems (ICD), and insurance practices.
- Proficiency in using computer software and databases for data entry, retrieval, and analysis.
- Strong attention to detail, analytical skills, and ability to multitask in a fast-paced environment.
- Excellent communication skills, both verbal and written, with the ability to interact professionally with diverse stakeholders.
Job Requirements
- Bachelor's degree is required
- Advance verbal and written communication skills
- Mid-level positions require +2 years of experience
- Healthcare provider organizations (hospitals, clinics, medical practices)
- Certified Professional( IFCE )
- Certified Professional (RCM )
Attractive for the ideal candidates.
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