Submission & Resubmission Team Lead

NMC; Abu Dhabi; On-site; AED 60,000 - 120,000; Full time

Job summary

NMC is seeking a Healthcare Claims Specialist to review and audit medical claims for accuracy in Abu Dhabi. You will ensure compliance with payer guidelines and manage claim resubmissions efficiently.

The role requires 2+ years in Insurance Claims Management/Adjudication, a Medical/Paramedical degree, and strong English communication. Experience in medical coding is a plus; joining duties include OSH and infection control adherence.

Qualifications

• Minimum 2 years of experience in Insurance Claims Management/Adjudication.
• Medical Coding experience is preferable.
• Medical/Paramedical degree from a recognized university.
• Excellent command of oral and written English.

Responsibilities

• Review and audit medical claims to ensure accuracy.
• Resubmission of rejected claims.
• Follow payer price lists and provider manuals when billing.
• Update Billing Officers on rejections and implement corrective actions.
• Submit claims with proper codes and formats within the timeframes.
• Comply with OSH and infection control policies.

Skills

Medical claims review

Claims resubmission

Insurance billing

OSH compliance

Infection control

Education

Medical/Paramedical graduate

Tools

Medical coding

Billing software

Job description

Job description

• Review and audit medical claims to ensure accuracy.
  • Resubmission of rejected claims.
  • Ensure that the agreed price list and provider manual from insurance companies are followed when billing services to the respective payers.
  • Ensure that Billing Officers are updated on rejections in a timely manner and corrective actions are taken to avoid similar instances in the future.
  • Handle the resubmission of rejected claims, follow up with respective doctors for claim justification, if necessary, and prepare claims for resubmission.
  • Submit claims with proper codes and formats to insurance companies within the stipulated time.
• Perform any other jobs or duties assigned by the HOD from time to time within the scope of the job title.
  • Comply with all OSH and infection control policies, standards and procedures, and cooperate with hospital management to meet these requirements.
  • Work in accordance with documented OSH procedures, instructions and specific responsibilities.
  • Be familiar with emergency and evacuation procedures.
  • Notify OSH of hazards, incidents, near misses and issues, and assist with the preparation of risk assessments and incident reports.
  • Comply with waste management procedures and policies.
  • Attend applicable OSH/infection control training programmes, mock drills and awareness programmes.
  • Use appropriate personal protective equipment and safety systems.

Responsibilities

• Review and audit medical claims to ensure accuracy.
• Resubmission of rejected claims.
• Ensure that the agreed price list and provider manual from insurance companies are followed when billing services to the respective payers.
• Ensure that Billing Officers are updated on rejections in a timely manner and corrective actions are taken to avoid similar instances in the future.
• Handle the resubmission of rejected claims, follow up with respective doctors for claim justification, if necessary, and prepare claims for resubmission.
• Submit claims with proper codes and formats to insurance companies within the stipulated time.
• Perform any other jobs or duties assigned by the HOD from time to time within the scope of the job title.
• Comply with all OSH and infection control policies, standards and procedures, and cooperate with hospital management to meet these requirements.
• Work in accordance with documented OSH procedures, instructions and specific responsibilities.
• Be familiar with emergency and evacuation procedures.
• Notify OSH of hazards, incidents, near misses and issues, and assist with the preparation of risk assessments and incident reports.
• Comply with waste management procedures and policies.
• Attend applicable OSH/infection control training programmes, mock drills and awareness programmes.
• Use appropriate personal protective equipment and safety systems.

Qualifications

• Medical/Paramedical graduate (Nursing, Pharmacy, etc.) from a recognized university.
• Minimum 2 years of experience in Insurance Claims Management/Adjudication.
• Experience in Medical Coding is preferable.
• Excellent command of oral and written English.