lavori da Claims Adjuster in località United States

We are looking for a proactive and service-focused Insurance Officer to join our team at HealthPlus IVF. The Insurance Officer is responsible for managing pre-approvals, eligibility verifications, and claim coordination with precision and efficiency — ensuring every patient journey remains seamless, compliant, and financially sound. The role supports IVF and Women’s Health clinical operations by guaranteeing that every procedure, lab test, and treatment package meets payer and DOH requirements from approval to reimbursement.

• Submit and track pre‑approval requests with detailed medical justifications aligned with DOH and payer medical necessity criteria.
• Verify patient eligibility, insurance coverage, and policy benefits through Emirates ID, payer systems, and EMR validation.
• Ensure all treatment and diagnostic codes are approved and reflected accurately in the EMR prior to service delivery.
• Coordinate with clinical teams to ensure documentation, approvals, and treatment notes are complete before billing.
• Follow up on pending approvals and rejections, ensuring timely resolution and maintaining transparent communication with payers and patients.
• Monitor approval expirations, manage extension requests, and maintain accurate logs for each patient encounter.
• Convert valid approvals into claims, reconcile submissions with the RCM system, and ensure alignment with bundle packages and storage renewals.
• Support audit readiness by maintaining comprehensive, organized approval records and logs compliant with DOH and ADHICS standards.
• Participate in continuous improvement initiatives to enhance workflow efficiency and patient satisfaction.

• Bachelor’s degree in healthcare, Business Administration, or a related field.
• 2–4 years of experience in insurance operations, pre‑approvals, or claims coordination in a healthcare setting, ideally IVF or women’s health.
• Familiarity with DOH standards, payer regulations, and UAE insurance protocols.
• Proficiency in EMR and RCM systems such as Meditex, OpenJet, and online payer portals.
• Excellent attention to detail, documentation discipline, and communication skills.
• Strong understanding of clinical documentation requirements and payer communication protocols.
• Fluency in English; Arabic proficiency preferred.