Associate - Claims Preparation & (Re) Submission

1 week ago


المملكة العربية السعودية, Saudi Arabia Sawaid Full time

**We are looking for a **" Associate - Claims Preparation & (Re) Submission "** to join a **Supportive Healthcare And Health Insurance** company in Saudi Arabia.**:
**The location work in Riyadh.**

**What your **Responsibilities**:

- All services provided to insured patients must be prepared in a defined claim format in order to reimburse incurred costs from the insurance companies.
- Responsible for preparing & submitting the monthly claims per payer’s protocol of billing and claim upon.
- Claim structure must be completed in its all medical, financial forms and supported by all reports and documents.
- Provides timely reports to relevant stakeholders.
- Collect Claim forms, pre-authorization/approvals forms, prescriptions, radiology reports, laboratory reports and all other medical reports relevant to invoices.
- Batch the claims per insurer and prepare cover letter for the submission.
- Request and follow up all discharge summaries, operative reports and medical reports needed for attachment with the claims.
- Properly process and audit all types of rejected claims received from payers, from the medical and technical perspective.
- Report back any type of claims observation or issues that may affect the process.
- Ensure that the medical ethics are respected at all times while performing the medical evaluation of the claims.
- Participate in developing the rules engine and the billing system by providing new ideas or proposals in order to enhance the process and control denials rate.
- Rectify and resubmit claims in an accurate and timely manner through proper channels to insurers/ TPAs and obtain receipt confirmation.
- Contribute in developing, updating and implementing the guidelines for evaluation and processing of medical claims, as well as policies and procedures and work instructions related to medical claims review and processing.
- Gather relevant information to clearly describe and properly escalate issues to supervisors and managers.
- Ensure that business decisions and processes are documented in a professional way and the communication requirements are being adhered to in a timely and professional manner.
- Conduct training to improve the technical, insurance and medical skills and knowledge for team members as assigned by the supervisor or manager.

**What are the requirements and qualifications required for the job**:

- 1 to 3 Years experience in Associate - Claims Preparation & (Re) Submission.
- Bachelor's degree.
- Excellent in English level.
- Good problem-solving abilities.
- Very Good in MS Office.
- Very Good in Operation System.


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