Medical Claims Officer - Roving

Riyadh, Saudi Arabia; Riyadh; On-site; SAR 150,000 - 200,000; Full time

Job summary

A healthcare organization in Saudi Arabia is looking for a qualified medical professional to manage inpatient cases. The role involves extracting and evaluating daily reports, investigating cases, and coordinating with site-delegates. Candidates should hold an MBBS and have at least 3 years of relevant experience, along with strong communication skills in English and Arabic. This position requires a clean driving license and the ability to work legally in the country.

Qualifications

• 3+ years of experience in a mid-to-large sized organization in a similar role.
• Clean and valid Driving license.
• Physically fit to carry out duties.
• Legally permitted to work in the country of operations.

Responsibilities

• Daily extraction of Inpatient report and assessment of cases.
• Investigate inpatient cases for accurate management plans.
• Coordinate with site-delegates for daily inpatient reporting.

Skills

Typing and communication skills in English & Arabic

Fluency in MS Office (Excel, Word, Outlook, PowerPoint)

General internet navigation and research skills

Education

Bachelor of Medicine and Bachelor of Surgery MBBS

SCFHS

Job description

Main Tasks

• Daily extraction of Inpatient report for cases within assigned region and daily assessment and evaluation of cases.
• Investigate inpatient cases in order to get the correct picture with justification including management plan and to follow thoroughly serious cases even though already roved.
• Coordinate with site-delegates to manage and prepare daily inpatient report.
• Provide a unified and standardized roving reports on daily basis. Consolidated weekly reports for visited in-patient cases and saving achieved are provided by the end of each week and by the end of each month.
• Coordinate for Cost Containment and savings measures including special discounts, transfer to low class/cost provider and case transfer to home country.
• In case of suspicious activities, data shall be collected and relevant function shall be informed for their necessary actions. E.g. FWA, Pre Cert .. etc
• To approve urgently required services/ procedures according to Standard Medical Practice and Evidence Based Medicine.
• Follow medical guidelines, practices and regulator ( IA ) instructions.

Minimum Requirements

• Bachelor of Medicine and Bachelor of Surgery MBBS
• 3+ years of experience in a mid-to-large sized organization in the similar role.
• SCFHS
• Typing and communication skills in English & Arabic.
• Clean and valid Driving license.
• Physically fit to carry out duties
• Legally permitted to work in the country of operations.
• Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.