Medical Claims Administrator

Combuzz; Dubai; On-site; AED 57,000 - 77,000; Full time

Benefits offered by this job

Company Benefits

Job summary

Combuzz seeks a qualified Medical Claims Administrator to review, process, and assess medical insurance claims in an outsourced setting within the UAE.

The role prefers candidates with healthcare backgrounds from hospitals, clinics, pharmacies, or healthcare providers. Medical claims/insurance experience is advantageous but not mandatory. Strong accuracy, discretion, and timely processing are essential.

Qualifications

• Qualified healthcare professional (e.g., RN or Pharmacist)
• Experience in hospital/clinic/pharmacy or healthcare provider环境 preferred
• Prior medical claims or health insurance experience is an advantage but not mandatory
• Strong understanding of medical terminology and documentation
• Familiarity with ICD-10, CPT, or similar coding standards a plus

Responsibilities

• Receive, review, and process medical insurance claims submitted by policyholders and providers.
• Review claims against policy terms, coverage limits, and medical necessity criteria.
• Verify accuracy and completeness of claim forms, medical records, invoices, and supporting documents.
• Investigate questionable or incomplete claims by contacting providers for more information.
• Analyze medical records to support claim assessment and decisions.
• Make recommendations on claim approvals, denials, or requests for additional information.
• Ensure timely processing and payment of approved claims.
• Coordinate with finance and third-party administrators as needed.
• Communicate claim status and required actions to stakeholders.
• Maintain accurate records of claims and correspondence.
• Ensure compliance with healthcare regulations and coding standards.

Skills

Medical claims processing

Healthcare industry experience

Attention to detail

Education

Registered Nurse

Pharmacist

Tools

Claims processing software

Job description

Position: Medical Claims Administrator

Employment Type: Outsourced Role

Location: UAE

Salary: AED 6,000 + Company Benefits

About the Role

We are looking for a qualified and detail-oriented Medical Claims Administrator to join our team on an outsourced assignment. The role will be responsible for reviewing, processing, and assessing medical insurance claims while ensuring accuracy, timely resolution, and compliance with relevant healthcare and insurance guidelines.

Candidates with a healthcare background who have worked in a hospital, clinic, pharmacy, healthcare provider, or similar medical environment are encouraged to apply. Previous medical claims or insurance experience is preferred but not mandatory.

Key Responsibilities

• Receive, review, and process medical insurance claims submitted by policyholders and healthcare providers.
• Review claims against policy terms, coverage limits, and medical necessity criteria.
• Verify the accuracy and completeness of claim forms, medical records, invoices, and supporting documentation.
• Investigate questionable or incomplete claims by contacting healthcare providers and requesting additional information where required.
• Review and analyse medical records and supporting documents to support claim assessment.
• Make recommendations or decisions regarding claim approvals, denials, or requests for additional information in line with policy guidelines.
• Ensure timely and accurate processing of approved claims for payment.
• Coordinate with finance teams and third-party administrators when required.
• Communicate professionally with policyholders, healthcare providers, and internal stakeholders regarding claim status and required actions.
• Maintain accurate records of claims, correspondence, investigations, and outcomes.
• Ensure compliance with applicable healthcare regulations, medical coding standards, company policies, and procedures.
• Support the team in maintaining high standards of accuracy, confidentiality, and service quality.

Requirements

Qualified Registered Nurse, Pharmacist, or other relevant healthcare professional.

Previous experience in a hospital, clinic, pharmacy, healthcare provider, or medical environment is preferred.

Prior experience in medical claims or health insurance is an advantage but not mandatory.

Good understanding of medical terminology and healthcare documentation.

Familiarity with ICD-10, CPT, or other medical coding standards is an advantage.

Strong attention to detail and analytical skills.

Good communication and interpersonal skills.

Ability to review and process confidential medical information with discretion.

Strong organizational skills with the ability to manage multiple claims and meet deadlines.

Good computer skills and ability to work with claims processing systems and Microsoft Office.

Benefits

AED 6,000 per month + Company Benefits