Job Description

Roles & Responsibilities

Job Location

Muscat,
Oman

Experience

8 to 10 years

Qualification Level

Graduate; Post Graduate; Medical Professionals

Job Function

Hospitality / Medicare / Account Management
Insurance / Claims

Skillset

Insurance submissions / claims and approvals

Preferred Jobseekers

Jobseekers from any country; Locally available candidates only apply for this job

should handle the insurance team independently
submit documents for Claims and follow it up until approved

Job Title: Head Insurance Approvals, Submission, and Claims
Location: Oman

Job Summary:
The Head of Insurance Approvals, Submission, and Claims is responsible for overseeing and managing all insurance-related activities within the hospital. This includes the timely processing of insurance approvals, accurate submission of insurance claims, and effective follow-up to ensure maximum reimbursements. The role requires close coordination with clinical, billing, and insurance teams to optimize revenue cycle efficiency while ensuring compliance with payer policies and regulatory guidelines.

Key Responsibilities:
1. Insurance Approvals & Pre-authorizations:
Supervise and manage the team responsible for obtaining timely pre-approvals from insurance providers.
Ensure complete and accurate documentation is submitted for pre-authorization requests.
Liaise with physicians, consultants, and diagnostic departments for required inputs.
Monitor turnaround time (TAT) for approval processes and address any delays.
2. Insurance Claims Submission:
Oversee the preparation and electronic/manual submission of insurance claims.
Ensure accuracy of coding (ICD-10, CPT, DRG), billing formats, and supporting documents.
Conduct periodic audits of submitted claims to reduce rejections and denials.
Coordinate with the billing and IT departments to ensure claims are integrated with HIS/ERP systems.
3. Claims Management & Reconciliation:
Manage end-to-end claims cycle from submission to final payment.
Track pending and rejected claims; analyze reasons and drive resolution.
Coordinate with insurance companies for claim status updates, escalations, and disputes.
Ensure timely reconciliation of insurance receivables with finance/accounts team.
4. Relationship Management:
Develop and maintain strong working relationships with insurance companies and TPAs.
Participate in regular meetings with payers to review performance, address concerns, and negotiate terms where needed.
5. Compliance & Policy Adherence:
Ensure all processes are in compliance with healthcare regulations, insurance guidelines, and hospital policies.
Maintain confidentiality and security of patient data and insurance information.
6. Team Leadership & Development:
Lead and mentor a team of insurance executives, coders, and billing specialists.
Conduct training sessions for staff on updates in insurance policies, coding standards, and claim handling procedures.
Monitor team performance and implement KPIs to improve efficiency.

Qualifications:
Bachelor s degree in healthcare administration, Business Management, Finance, or related field.
Preferred: Master s Degree (MBA / MHA), or certifications in medical coding (CPC, CCS).
Experience: Minimum 8 10 years of experience in hospital insurance operations, with at least 3 5 years in a leadership role.
Strong knowledge of insurance practices in the GCC region, especially Oman.
Familiarity with health insurance systems, TPAs, and international insurance protocols.
Proficiency in HIS and insurance claim management software.

Key Skills:
Deep understanding of medical insurance processes (approvals, coding, billing, reimbursements).
Strong leadership, communication, and negotiation skills.
Analytical and problem-solving capabilities.
Detail-oriented with a high level of accuracy.
Ability to manage multi-functional teams and handle high-pressure situations.

Company Profile

We are one of the leading hospital in Oman.

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