Medical Claims Auditor - Audit Reimbursements & Compliance

Flip retail; Dubai; On-site; AED 112,000 - 145,000; Full time

Job summary

Flip retail is seeking a Medical Claims Auditor - Insurance to review and audit medical insurance claims, including inpatient and outpatient reimbursements. The role involves coordinating with providers and payers to resolve billing mismatches and conducting external audits of carriers, with a focus on medical coding accuracy and potential fraud detection.

The position requires updating external audit records and interacting with various groups (Claim Centre, Network Team, IT) to ensure proper

Qualifications

• Experienced in medical case auditing within insurance policies or TPAs.
• Experience with inpatient and outpatient reimbursement claims.
• Maintaining internal audit records of claims handling.
• Handling inquiries from Claims Group on medical coding (DRG, upcoding, medically justified).
• Interacting with Claims Centre, Network Team and IT on medical coding.

Responsibilities

• Coordinate with providers or payers to resolve mismatches between declarations and billing submissions.
• Conduct external audits of carriers, including clinical documents and payments.
• Update external audit records to the monitoring system.
• Investigate inpatient and outpatient insurance claims reimbursements.
• Preserve internal audit records of claims processing.
• Respond to Claims Group inquiries regarding medical coding.

Skills

Medical claims auditing

Medical coding

Fraud detection

Tools

DRG coding

Job description

Flip retail is seeking a Medical Claims Auditor - Insurance to review and audit medical insurance claims, including inpatient and outpatient reimbursements. The role involves coordinating with providers and payers to resolve billing mismatches and conducting external audits of carriers, with a focus on medical coding accuracy and potential fraud detection.

The position requires updating external audit records and interacting with various groups (Claim Centre, Network Team, IT) to ensure proper