Insurance Claims Specialist - Resubmission

AlFuttaim; Dubai; On-site; AED 100,000 - 145,000; Full time

Job summary

Al-Futtaim Health in Dubai is seeking an experienced Insurance Claims Specialist - Resubmission to manage rejected inpatient, outpatient, and pharmacy claims, ensuring accurate resubmission, and strengthening payer communication.

You will analyze denials, collect medical justification, collaborate with clinical and billing teams, and help reduce revenue leakage while meeting DHA requirements and performance targets.

Qualifications

• Minimum 3 years in healthcare claims resubmission, insurance reconciliation, denial management, medical coding, or a closely related revenue cycle role.
• Strong understanding of DHA regulations and medical documentation requirements.
• Experience communicating with insurance companies and resolving disputed claims.

Responsibilities

• Review rejected inpatient, outpatient, and pharmacy claims and determine eligibility for resubmission.
• Submit corrected claims within required timelines with medical justification.
• Escalate unusual denial patterns or payer-related issues to the Insurance Manager for review.
• Coordinate with Insurance Approvals and Claims Submission teams to reduce avoidable denials.
• Maintain resubmission KPIs and monitor turnaround time, quality, and productivity targets.

Skills

Healthcare claims resubmission

Insurance claims management

Claims reconciliation

Medical coding

Professional coding certification

Inpatient claims

Outpatient claims

Pharmacy claims

Denial analysis

Payer communication

Revenue cycle management

Clinical documentation improvement

QMS follow-up

Education

Certified medical coder / Medical coding certification

Tools

Healthcare billing software

Payer portals

EHR/EMR systems

Job description

Job Snapshot

Insurance Claims Specialist - Resubmission Job Snapshot Role: Insurance Claims Specialist - Resubmission Location: Dubai, United Arab Emirates Industry: Hospital and Health Care Function: Hospital-Clinic Administration Experience: Minimum 3 years Job Type: Full-time

Position Overview

Insurance Claims Specialist - Resubmission in Dubai, United Arab Emirates is a Hospital and Health Care opportunity focused on rejected insurance claims, resubmission, reconciliation, denial analysis, payer communication, and healthcare revenue cycle performance. Al-Futtaim Health is hiring an experienced claims professional to improve reimbursement outcomes, reduce recurring denials, support accurate medical documentation, and strengthen coordination with insurance companies and internal clinical teams.

Job Details

Country: United Arab Emirates City: Dubai Industry: Hospital and Health Care Function: Hospital-Clinic Administration Salary: 9000-13000 Estimated salary range based on similar jobs in the job city; please confirm the final offer with the employer. Gender: Any Candidate Nationality: Any Job Type: Full-time

Role Context

The Insurance Claims Specialist is responsible for reviewing, correcting, and resubmitting eligible inpatient, outpatient, and pharmacy claims that have been rejected by insurance companies. The role requires detailed examination of payer responses, clinical documentation, coding information, authorization records, and technical claim data to determine the appropriate corrective action. The position also supports broader denial prevention by identifying recurring rejection patterns and working with Insurance Approvals, Claims Submission, Clinical Documentation Improvement, physicians, billing teams, and other stakeholders. Accurate resubmission and timely reconciliation directly contribute to stronger collections, reduced revenue leakage, and more predictable healthcare cash flow.

Key Responsibilities

• Review rejected inpatient, outpatient, and pharmacy claims and determine eligibility for resubmission.
• Submit corrected claims within required timelines using appropriate medical and technical justification.
• Escalate unusual denial patterns or payer-related issues to the Insurance Manager for review and resolution.
• Communicate with insurance companies for clarification during first resubmission and second resubmission or reconciliation stages.
• Obtain clinical justification from physicians when rejected claims require additional medical support.
• Coordinate with Insurance Approvals and Claims Submission teams to reduce avoidable claim denials.
• Follow up internally on raised QMS cases with the relevant branches until appropriate closure is achieved.
• Ensure all resubmission activity complies with DHA requirements, payer rules, contractual terms, and healthcare insurance procedures.
• Maintain resubmission KPIs and monitor performance against defined turnaround time, quality, and productivity targets.
• Analyze denial root causes across different payers and collect supporting feedback from relevant team members.
• Recommend system rules or process controls that can prevent recurring technical or medical denials.
• Work with billing and approval teams to improve workflow accuracy and reduce preventable rejection causes.
• Coordinate with the Clinical Documentation Improvement team to strengthen physician and paramedical documentation.
• Maintain accurate monthly records for claims resubmission and reconciliation by insurance company.
• Prepare detailed denial reports separating technical denials from medical denials.
• Use denial data to support focused training, documentation improvement, and process correction initiatives.
• Identify payment discrepancies from insurance companies and elevate material issues to line management.
• Coordinate with internal business stakeholders to improve resubmission and reconciliation efficiency.
• Analyze revenue cycle financial information to identify defaulting or high-risk payers.
• Support corrective strategies designed to reduce financial exposure associated with delayed or disputed payments.
• Work on complex claims requiring specialist medical knowledge, technical interpretation, or IT support.
• Maintain high accuracy while working under pressure to meet resubmission and reconciliation deadlines.

Ideal Profile

Candidates should hold a recognized professional coding certification together with a certified medical or paramedical qualification. A strong medical background is important because the role involves reviewing rejected claims, understanding clinical documentation, and determining whether payer objections are medically or technically justified. A minimum of three years of experience in healthcare claims resubmission, insurance reconciliation, denial management, medical coding, or a closely related revenue cycle role is required. The successful candidate should understand healthcare insurance processes, DHA regulations, claims documentation, payer requirements, and the distinction between medical and technical denials. Experience communicating directly with insurance companies and resolving disputed claims will be particularly valuable. Strong analytical judgment, negotiation ability, decision‑making, operational thinking, presentation skills, and resilience under demanding turnaround targets are essential for consistent performance.

Skills Set

• Healthcare claims resubmission
• Insurance claims management
• Claims reconciliation
• Medical coding
• Professional coding certification
• Inpatient claims
• Outpatient claims
• Pharmacy claims
• Medical denial analysis
• Technical denial analysis
• Denial root-cause analysis
• Insurance payer communication
• Revenue cycle management
• Clinical justification review
• Claims documentation
• DHA insurance regulations
• Insurance approvals
• Claims submission
• Clinical Documentation Improvement
• Physician coordination
• Healthcare billing
• QMS follow-up
• Resubmission KPI tracking
• Turnaround time management
• Payment discrepancy analysis
• Payer performance monitoring
• Financial risk identification
• Revenue leakage reduction
• Reconciliation reporting
• Process improvement
• Insurance negotiation
• Analytical reporting

Why Join Us

This position offers direct involvement in one of the most financially important areas of healthcare administration, where effective claims recovery and denial prevention can materially improve revenue performance. The role provides exposure to clinical documentation, payer negotiations, medical coding, financial analysis, and insurance operations within a large healthcare network. Al‑Futtaim Health provides an environment where an experienced claims professional can strengthen expertise in complex resubmission and reconciliation while contributing to process improvements that reduce future denials. The experience can also support progression into senior revenue cycle, insurance operations, payer management, or healthcare financial administration roles.

About the Company

Al‑Futtaim is a diversified regional group headquartered in Dubai with businesses across healthcare, automotive, retail, real estate, and financial services. Through Al‑Futtaim Health and its HealthHub network, the organization delivers multidisciplinary healthcare services supported by integrated clinical, insurance, billing, and revenue cycle operations.