Insurance Administrative

My Clinic KSA; Riyadh; On-site; SAR 201,000 - 312,000; Full time

Job summary

My Clinic, the leading multispecialty outpatient care provider in Saudi Arabia, is hiring for an Insurance Claims Specialist. You will determine coverage, process claims, and ensure compliance across insurers, NPHIES and portals.

Ideal candidates are bilingual in English and Arabic, with strong communication, analytical mindset, and detail orientation. You will collaborate with medical and operations teams to resolve denials and optimize processing times.

Qualifications

• Degree in medical or business related subjects.
• Proven communication with internal and external customers.
• Detail oriented with numbers and documentation.

Responsibilities

• Evaluate requests (investigations and medications) medically and coverage according to policy policies and TOB.
• Submit requests through NPHIES or insurer portals within the required timelines.
• Follow up with insurance companies on replies.
• Coordinate with My Clinic medical team for justification when needed.
• Coordinate with My Clinic operations teams on insurer decisions.
• Prepare a tracker for abnormal trends to assist doctor awareness sessions.
• Maintain flexible timing as required.
• Ensure accountability for correct policy decisions.

Skills

Bilingual English/Arabic

Teamwork

Communication

Problem-solving

Analytical mindset

Numeric skills

Detail oriented

Education

Degree in Medical/Business

Tools

Microsoft Office

Job description

Join My Clinic, the leading multispecialty outpatient care provider in Saudi Arabia, where our mission to help people live longer, healthier, and happier lives drives everything we do. Since 2017, we've been at the forefront of healthcare, combining innovation with a deep commitment to care, collaboration, ambition, and responsibility. As we continue to grow and reach new heights, we're looking for passionate individuals who share our vision and values

Job Summary:

Serves medical insurance customers by determining insurance coverage; examining and resolving medical claims; documenting actions; ensuring legal compliance.

Primary Responsibilities:

• Evaluation of the requests (investigations and medications) medically and coverage according to the Basic CCHI policy and patient insurance Table of Benefits (TOB).
• Handling the submission of requests through NPHIES and/or different insurance companies’ portal within specific time
• Follow up the reply from the insurance companies.
• Communicate with My Clinic medical team for justification if required.
• Communicate with My Clinic operation teams (Reception and customer service) the insurance companies` decisions.
• Preparation of tracker for the abnormal trend (investigations and medications) of the doctors to be helpful in awareness sessions with the doctors to decrease the medical rejection.
• A doubting for the flexible timing
• Accountability and responsibility on wrong Policy decision.

Education / Professional Qualifications:

• Good Team Worker
• Good communication skills dealing with both internal and external customers.
• Degree educated in Medical/business related subjects.

Experts & Skills:

• Excellent Command of oral and written English & Arabic.
• Proficient with Microsoft Office Suite or related software .
• Details oriented.
• Excellent problem-solving skills and the ability to strategize and devise solutions.
• Outstanding analytical mindset and comfort working with numbers.