Medical Claims Officer

2 weeks ago


Khobar, Eastern Province, Saudi Arabia Saudi Petroleum Services Polytechnic Full time

Key Responsibilities

  • Process outpatient claims daily in adherence to medical policies and guidelines.
  • Review claims data (physical and electronic) to ensure accuracy and compliance with operational checklists.
  • Maintain accuracy rate in quality audits and meet daily processing targets.
  • Identify unusual provider patterns and escalate potential fraud to the Supervisor of Medical Claims and Special Investigations Unit (SIU).
  • Collaborate with senior staff on complex claims cases to ensure sound medical decisions.

Qualifications

Education:

  • Bachelor's degree in Dental, Physiotherapy, Pharmacy, or a related medical field.

Experience:

  • A minimum of 2 years in health insurance is preferred.
  • Fresh graduates with relevant educational backgrounds are encouraged to apply.

Skills

  • Strong analytical, quantitative, and problem-solving skills.
  • Excellent communication, interpersonal, and organizational abilities.
  • High level of self-motivation and a proactive approach to challenges.
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