Medical Claims Processing Specialist

1 month ago


Riyadh, Ar Riyāḑ, Saudi Arabia ADDAR GROUP Full time

We are looking for a Medical Claims Processing Specialist for an Insurance Domain Client in Riyadh.

  • Process daily batches of claims (Direct Billing and RI claims) according to medical policy and Inpatient adjudication guidelines, using medical background alongside instructed guidelines for smooth business operations.
  • Achieve daily processing target within regulatory timeframe.
  • Ensure claims are paid according to eligible benefits and coverage.
  • Discuss high profile/value claims with claims medical manager/TL for complex decisions.
  • Monitor and report medical abuse, refer fraud claims to Audit and investigation team.
  • Identify price calculation discrepancies, report over-invoiced claims to Network team.
  • Apply medical expertise to handle claim rejections.
  • Support in additional tasks assigned by claims Manager/TL.


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