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Medical Insurance Senior Specialist

3 weeks ago

المملكة العربية السعودية, Saudi Arabia Nahdi Full time

This role will be leading and managing the medical approvals, insurance claiming and Billing process with insurance companies and credit corporate sales accounts. Also working to minimize the rejections and collect payments within due dates to improve polyclinic profitability.

**Accountabilities**
- Medical Insurance Head Working on instant approvals for insurance guests, analyzing day to day data in order to improve the claiming process and operations.
- Reviewing and verifying the claims and all the required data/information.
- Verifying and checking the reports matching with “waseel” insurance companies’ systems (Tawuniya, DHS and Bupa).
- Communicating and negotiating with insurance companies in case of claims rejections to minimize it before reconciliations.
- Experience with healthcare provider in insurance will be an added point.
- Reviewing patient records using medical coding procedures.
- Examine claims, verify insurance eligibility, and record any medical charges and other payments or adjustments.
- Detecting any coding errors or performing any modifications needed.
- Assisting patients in obtaining and understanding medical benefits.
- Communication with other medical staff members and health insurance providers often occurs.
- Responsible for updating any internal databases, which electronically store and organize patients' records, billing details, and registration forms.
- Liaise with concerned departments on their medical insurance claims and finalize it with other teams (Finance, IT..etc)

Employee’s duties are not limited only to the above-mentioned Accountabilities; he/she may perform other duties as assigned.

**Work Environment**
- Indoors : 100%
- Outdoors : 0%
- Working Days : 6 Working Days
- Days off : 1 Day Off
- Working Hours : 8 hours Shifts to ensure continuous attendance to reception. (with 1 hour Rota break)

**Job Requirement**

**Education
- **High School Diploma (Preferably University Graduate)
**Experience
- **2years in Medical Insurance
**Computer Skills
- **Microsoft Office
**Languages
- **English and Arabic (fluent spoken and written)