Claim Adjuster

Al Ahly Medical Company

Review and analyze insurance claims to determine coverage and liability in accordance with company policies and procedures.

Investigate and validate the authenticity of claims by gathering relevant documentation and evidence from claimants, healthcare providers, and other stakeholders.

Communicate with clients, healthcare providers, and internal departments to clarify information and resolve discrepancies in claims.

Assess medical records, invoices, and supporting documents to ensure accuracy and compliance with regulatory standards.

Negotiate settlements with claimants and providers within established authority limits, ensuring fair and timely resolution.

Document all claim activities, decisions, and communications in the claims management system for audit and reporting purposes.

Collaborate with the fraud prevention team to identify and escalate suspicious or fraudulent claims.

Provide clear explanations of claim decisions and processes to clients and stakeholders.

Stay updated on industry regulations, company policies, and best practices related to claims adjustment.

Participate in training sessions and contribute to process improvement initiatives to enhance claims management efficiency.