Clinical Claims Validator – Medical Billing & Compliance

My Clinic KSA; Jeddah; On-site; SAR 120,000 - 180,000; Full time

Job summary

My Clinic in Saudi Arabia seeks a Claims Validation Specialist to support the Medical Operations function by performing clinical review of insurance claims before submission. You will ensure medical necessity, documentation completeness, coding consistency, and adherence to payer requirements to support growing claim volumes and new branch expansion.

The role involves coordinating with physicians and multiple teams to resolve discrepancies, mitigate rejections, and improve clean-claim quality.

Qualifications

• Bachelor’s degree in medicine or equivalent medical/clinical qualification.
• Minimum 2 years of experience in healthcare, medical insurance, claims review, utilization review, or Revenue Cycle Management.
• SCFHS license (if applicable) may be advantageous; professional certifications in medical coding or revenue cycle management preferred.

Responsibilities

• Perform detailed clinical review and validation of medical claims prior to submission.
• Validate medical necessity, diagnosis, investigations, procedures, medications, and care plans against patient records.
• Review claim documentation for completeness and consistency, including physician notes and supporting documents.
• Identify risks that may lead to claim rejection or write-offs and coordinate corrections within submission timelines.
• Coordinate with clinicians and operations teams to clarify discrepancies and complete required corrections.

Education

Bachelor’s degree in medicine / MBBS / MD

Job description

My Clinic in Saudi Arabia seeks a Claims Validation Specialist to support the Medical Operations function by performing clinical review of insurance claims before submission. You will ensure medical necessity, documentation completeness, coding consistency, and adherence to payer requirements to support growing claim volumes and new branch expansion.

The role involves coordinating with physicians and multiple teams to resolve discrepancies, mitigate rejections, and improve clean-claim quality.