Insurance Claims Submissions & Reconciliation Specialist

Al Futtaim Private Company (LLC); Dubai; On-site; AED 90,000 - 150,000; Full time

Job summary

Al Futtaim Private Company (LLC) is seeking a claims specialist with a strong medical background to reconcile and process IP OP and Pharmacy claims while ensuring compliance with DHA regulations.

You will collaborate with physicians, insurance approvals, and coding teams to minimize denials, improve submission accuracy, and meet KPIs through meticulous documentation and stakeholder coordination.

Qualifications

• Strong medical background to handle reconciliation efficiently.
• Strong Negotiation skills.
• Strong soft skills.

Responsibilities

• Ensure timely submissions of all eligible IP OP and Pharmacy claims with proper medical and technical justification
• Internal Follow up for raised QMS to concerned branch
• Interacting with the physicians for the clinical justification of the claims
• Ensure and work closely with the team on complex cases that need experience and specialist knowledge or technical IT support
• Work closely with Insurance Approvals and Claims re-submission Team to minimize the claims denials
• Making sure that claim submissions are dealt with according to Insurance industry and DHA regulations
• Comply with submission KPI s Key Performance Indicator maintain a record of submission KPIs as and when required
• Educate billing Approval team to enhance the process flow
• Ensures that targets are met within turnaround time and while maintaining quality and productivity
• Coordinate with CDI team to educate the physicians and other paramedical team to ensure proper claims documentations
• Maintain accurate monthly data of claims submissions of each insurance company
• Coordination with other business stakeholders to improve overall submission process efficiency
• Analysis of financial data related to revenue cycle to identify defaulting payers and work with the concern department on corrective strategies to mitigate the financial risks

Skills

Medical background

Negotiation

Soft skills

Education

Coding certificate

Medical/paramedical certificate

Job description

Al Futtaim Private Company (LLC) is seeking a claims specialist with a strong medical background to reconcile and process IP OP and Pharmacy claims while ensuring compliance with DHA regulations.

You will collaborate with physicians, insurance approvals, and coding teams to minimize denials, improve submission accuracy, and meet KPIs through meticulous documentation and stakeholder coordination.