Medical Claims Operations Manager

Tawuniya Insurance Company; Riyadh; On-site; SAR 89,000 - 134,000; Full time

Job summary

Tawuniya Insurance Company in Riyadh is seeking a qualified medical claims professional to process and evaluate medical claims accurately, ensuring adherence to coverage scope, provider contracts, and CHI/IA regulatory requirements. You will support data-driven claims management and participate in quality initiatives.

Join a team focused on timely processing, regulatory compliance, and continuous improvement, contributing to high-quality healthcare claim outcomes in a dynamic insurance

Qualifications

• MBBS degree required; Master degree is a plus.
• 1 year of experience in medical field.
• 4–5 years of experience in insurance industry, preferably medical claims.

Responsibilities

• Process assigned claims from creation through closing with agreed turnaround times.
• Ensure adjudication decisions comply with CCHI regulations, Insurance Authority requirements and Tawuniya policy.
• Review internal quality-review findings and implement corrective actions.
• Provide data-driven claims management support and participate in VBHC/DRG/PHM initiatives.
• Deliver KPIs and contribute to continuous improvement through Kaizen initiatives.

Skills

Medical claims knowledge

Regulatory awareness

Education

MBBS degree

Master degree

Job description

Tawuniya Insurance Company in Riyadh is seeking a qualified medical claims professional to process and evaluate medical claims accurately, ensuring adherence to coverage scope, provider contracts, and CHI/IA regulatory requirements. You will support data-driven claims management and participate in quality initiatives.

Join a team focused on timely processing, regulatory compliance, and continuous improvement, contributing to high-quality healthcare claim outcomes in a dynamic insurance