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Claims Officer (Abu Dhabi) - Major Healthcare TPA

Confidential Company

Posted on August 14, 2019

1 - 4 years Dubai - United Arab Emirates

Any Graduation, Bachelor of Science(Nursing), Bachelor of Pharmacy(Pharmacy). Any Nationality, Any Arabic National, Indian

Annual ticket, Medical & Life covers & visa/sponsorship

Opening 01

Job Description

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Duties and responsibilities:

To approve reimbursement claims based upon member coverage & medical justification.
 To assist queries from providers and payers via phone calls or e-mails
 To maintain files for authorizations and other reports.
 Processing claims in line with the policy coverage and medical necessity.
 Be fully versed with medical insurance policies for various groups / beneficiaries.
 Might be required to assist in training colleagues and sharing knowledge.
 Able to accurately assess eligibility within the UAE (HAAD and DHA) guidelines as well as policy boundaries.
 Monitoring and maintaining the claims processing and adjudicating cycle in operational software system as per the defined terms and policy of the organization.
 Establishing strategies and implementing effective parameters for solving all possible queries within the team.
 Taking a lead role in assuring that the assigned tasks to the team are completed within the allocated time frame.
 Ensures the proper communication and implementation of new formats, training and processing rules.
 Maintaining both qualitative and quantitative claims measures.
 Ensure adherence to the predefined TATs for claims and pre-approvals
 Achieving required processing targets assigned by the team leader or supervisor on daily, weekly and monthly basis.
 Ensure compliance to any changes in terms of system parameters or process.
 Successfully pass the monthly audit sampling of own claims.


Desired Candidate Profile

 University degree in any discipline of Medical/Para-medical specialization from a reputable university.
 Healthcare/Hospital experience for 1-2 years, in departments such as Surgery, ICU or GP, is required.
 1 - 2 years of work experience in the Insurance industry is preferable but not mandatory.
 Excellent oral and written communication skills.
 Must be computer literate.
 Excellent command of the English language, Arabic is a definite plus.
 Should be a team player with an aptitude for customer service. Must be service oriented.
 Highly decisive with outstanding logic and reasoning skills.
 Candidate must be tactful and discrete while dealing with Providers or Payers; must be able to handle confidential information.
 Ability to work under pressure and meet tight deadlines and varying work-schedules.


Claims officer Authorization Insurance Coordinator insurance specialist Claims Adjudication Claims Processing Claims Management Case Management CPC ICD-10

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