Find a job, a company, or an NGO KEY RESPONSIBILITIES:
- Evaluate and verify medical claims to ensure clinical accuracy and compliance with policy guidelines and regulatory standards.
- Review patient records, medical reports, and supporting documentation to facilitate accurate claim evaluation and processing.
- Provide healthcare providers with medical justifications for rejected claims in line with international and Saudi medical guidelines.
- Negotiate and resolve disputed claims directly with healthcare providers when required.
- Achieve daily claims targets as assigned by the Claims Manager approved by Head of Medical.
- Collaborate with other departments to verify claim amounts, status, and related information.
- Support efficient, accurate, and compliant claims management through timely decision-making and communication.
Minimum Qualifications:
- Medicine Bachelor’s degree (MBBS).
- Licensed by the Saudi Commission for Health Specialties (SCFHS).
