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Medical Claims Officer

2 months ago

Riyadh, Ar Riyāḑ, Saudi Arabia Ammanu Full time

Job Opportunity at Ammanu

We are seeking a skilled Medical Claims Officer to join our team in Riyadh, KSA.

Key Responsibilities:

  1. Process daily batches of claims in line with medical policy and Inpatient adjudication guidelines.
  2. Achieve daily targets for claims processed within regulatory timeframes.
  3. Ensure claims are paid according to eligible benefits and coverage.
  4. Discuss high-profile claims with the claims medical manager/TL where decisions are difficult.
  5. Monitor medical abuse and refer suspected fraud claims to the Audit and investigation team.
  6. Identify price discrepancies and report over-invoiced claims to the Network team.
  7. Apply medical expertise to reject claims where applicable.
  8. Assist with additional tasks assigned by the claims Manager/TL.

Requirements:

MBBS degree and relevant experience in the insurance domain.

How to Apply:

Please send your CV to the relevant contact.