Claims Officer
Job Description
Your Role:
· Manage daily claims administration work of review and processing of claims in line with scope of coverage and provider contracts.
· Audit claims data to identify any Fraud waste and abuse activities.
· Ensure accuracy and consistency of data.
· Forward approved claims once processed to PICs (Preferred Insurance Companies) for their acknowledgment or approval as per thresholds.
· Review and respond to claims audits of clients and internal audits.
· Answering provider, Insured members, and PICs queries accurately via phone calls and emails, regarding claims processing to provide clarifications where needed.
· Work in accordance with defined SOP’s.
· Work with high efficiency, minimizing errors and administration time to achieve monthly deadlines.
· Entering data accurately to provide accurate records to the company and PICs.
Your profile:
. Computer literate and excellent knowledge of MS office.
· Excellent interpersonal and communication skills.
· Working on split or straight shifts according to business needs.
· Very good command of English.
· Ability to communicate sensitively and effectively with internal and external stake holders having regard for the strict need for confidentiality.
· Advanced knowledge of Microsoft packages (Word, PowerPoint, and Excel) e-mail, electronic calendar, and the Internet.
· Ability to work well with all levels of internal management and staff, as well as outside clients.
Minimum Qualifications:
· Diploma In Nursing, Physiotherapy and Pharmaceutical Sciences.
· Coding certifications is an added advantage.
. Must be a UAE National and have a Family Book.
Minimum Experience:
· 2-3 years of experience in claims in the insurance industry or TPA/MSO Company.
Your Role:
· Manage daily claims administration work of review and processing of claims in line with scope of coverage and provider contracts.
· Audit claims data to identify any Fraud waste and abuse activities.
· Ensure accuracy and consistency of data.
· Forward approved claims once processed to PICs (Preferred Insurance Companies) for their acknowledgment or approval as per thresholds.
· Review and respond to claims audits of clients and internal audits.
· Answering provider, Insured members, and PICs queries accurately via phone calls and emails, regarding claims processing to provide clarifications where needed.
· Work in accordance with defined SOP’s.
· Work with high efficiency, minimizing errors and administration time to achieve monthly deadlines.
· Entering data accurately to provide accurate records to the company and PICs.
Your profile:
. Computer literate and excellent knowledge of MS office.
· Excellent interpersonal and communication skills.
· Working on split or straight shifts according to business needs.
· Very good command of English.
· Ability to communicate sensitively and effectively with internal and external stake holders having regard for the strict need for confidentiality.
· Advanced knowledge of Microsoft packages (Word, PowerPoint, and Excel) e-mail, electronic calendar, and the Internet.
· Ability to work well with all levels of internal management and staff, as well as outside clients.
Minimum Qualifications:
· Diploma In Nursing, Physiotherapy and Pharmaceutical Sciences.
· Coding certifications is an added advantage.
. Must be a UAE National and have a Family Book.
Minimum Experience:
· 2-3 years of experience in claims in the insurance industry or TPA/MSO Company.
