Direct Billing Claims Assessor
Confidential Company
Multiple Vacancies
Posted 30+ days ago
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Education
MBBS(Medicine)
Nationality
Any Nationality
Gender
Any
Vacancy
24 Vacancies
Job Description
Roles & Responsibilities
- Evaluate and process medical insurance claims in line with company policy and medical best practices.
- Assess eligibility and completeness of submitted claims and escalate complex cases to the Senior Claims Officer.
- Handle pre-authorizations, provider interactions, and documentation reviews to ensure timely and accurate claims processing.
- Detect potential fraudulent claims and report suspicious activity as per company protocols.
- Maintain accurate records of paid, pending, and rejected claims in the internal system.
- Communicate with insured members, clinics, and clients regarding claim statuses and required documentation.
- Assist in processing reinsurance claims and liaising with customer service on escalated medical queries.
- Ensure adherence to internal KPIs, compliance requirements, and QCB regulations.
- Contribute to continuous improvement efforts in claims processing procedures and reporting.
Desired Candidate Profile
- Education: MBBS or Degree/Diploma in Nursing/Medical field is mandatory.
- Minimum 2+ years of experience in handling medical claims; fresh MBBS graduates may also be considered.
- Strong understanding of medical terminology, insurance policies, and claims authorization.
- Excellent communication skills in English; Arabic language proficiency is a strong advantage.
- Proficient in MS Office and medical claims systems; accurate documentation and attention to detail required.
- Must be able to clearly explain medical concepts and justify decisions in a customer-facing setting.
- Should be comfortable working in a non-clinical environment.
Important Note:
- Rotational shifts including night shifts are mandatory as the department operates 24/7.
- Preference will be given to bilingual candidates (Arabic & English) for improved communication and service quality.
- Contract Duration: One year.
- Interview schedule will be communicated upon profile shortlisting.
- Please submit profiles immediately, ensuring candidates match the medical/surgical or MBBS background and experience criteria.
Employment Type
- Contract
Company Industry
- Insurance
Department / Functional Area
- Other
Keywords
- Medical Claims Assessor
- Medical Billing
- Healthcare Claims Adjudicator
- Medical Claims Processor
- Health Insurance Claims
- TPA Claims
- Medical Insurance
- Reimbursement Claims
- MBBS
- Medical Claims Management
- Medical Claims Review
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Confidential Company
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