Health and Dental Claims Analyst

Info Resume Edge; Sharjah; On-site; AED 120,000 - 200,000; Full time

Job summary

A healthcare consultancy in Sharjah is seeking a Health and Dental Claims Analyst to manage the review, analysis, and processing of insurance claims. Ideal candidates will have a Bachelor's degree and over 5 years of experience in claims processing, with strong knowledge of insurance coding and healthcare regulations. This role requires excellent analytical and communication skills to ensure compliance with policy coverage and standards while maintaining proper documentation.

Qualifications

• 5+ years of experience in claims processing health insurance or dental benefits.
• Knowledge of ICD-10, CPT, ADA codes and healthcare reimbursement systems.
• Familiarity with healthcare regulations such as HIPAA.

Responsibilities

• Review and analyze incoming health and dental claims for accuracy and eligibility.
• Ensure claims comply with policy coverage terms and regulatory standards.
• Investigate and resolve discrepancies in submitted claims.

Skills

Analytical skills

Attention to detail

Communication skills

Organizational skills

Education

Bachelor's degree in Healthcare Administration, Business or related field

Tools

Claims adjudication systems

Microsoft Office tools

Job description

The Health and Dental Claims Analyst is responsible for reviewing analyzing and processing health and dental insurance claims. The role ensures that claims are adjudicated accurately and in accordance with policy provisions guidelines and regulatory requirements. The ideal candidate will have strong analytical skills attention to detail and knowledge of health and dental benefit plans

Key Responsibilities

• Review and analyze incoming health and dental claims for accuracy and eligibility.
• Ensure claims comply with policy coverage terms and regulatory standards.
• Investigate and resolve discrepancies or inconsistencies in submitted claims.
• Apply appropriate fee schedules adjudication rules and coding practices (ICD CPT ADA codes).
• Communicate with healthcare providers policyholders and internal departments for additional information as needed.
• Process approvals or denials in the claims management system.
• Maintain proper documentation and audit trail of claims decisions.
• Monitor and report trends or issues related to claims processing.
• Stay updated with changes in insurance policies coding and compliance regulations.
• Support audits compliance checks and quality assurance reviews.

Qualifications

• Bachelor's degree in Healthcare Administration Business or a related field (preferred).
• 13 years of experience in claims processing health insurance or dental benefits.
• Knowledge of ICD-10 CPT ADA codes and healthcare reimbursement systems.
• Familiarity with healthcare regulations such as HIPAA.
• Proficient with claims adjudication systems and Microsoft Office tools.
• Strong attention to detail analytical and organizational skills.
• Excellent written and verbal communication skills.