Medical Claims Processing Supervisor

Walaa Cooperative Insurance Company; Saudi Arabia; On-site; SAR 200,000 - 300,000; Full time

Job summary

A leading insurance provider in Saudi Arabia is seeking a Claims Processing Supervisor to oversee daily claims operations and ensure adherence to regulatory standards. The role involves supervising a team, implementing internal controls, and preparing performance reports. Ideal candidates should have a bachelor's degree, significant experience in medical claims processing, and strong analytical skills. Fluency in Arabic is required, and knowledge of English is advantageous.

Qualifications

• 3–5 years of hands-on experience in Medical Claims Processing domain.
• 5+ years in Healthcare Insurance & Regulatory Compliance preferred.
• Understanding of Medical Claims Processing.

Responsibilities

• Support the Manager in supervising daily claims processing.
• Implement internal controls to ensure claims accuracy.
• Investigate claim discrepancies and ensure timely resolution.
• Act as contact point for healthcare providers and stakeholders.
• Prepare operational dashboards for management.

Skills

Integrity & Ethical Mindset

Attention to Detail

Analytical Thinking

Critical Thinking

Persistence & Patience

Communication Skills

Confidentiality & Discretion

Adaptability

Education

Bachelor’s degree in Medicine / Pharmacy, Healthcare Administration, Business Administration or Health Informatics

Tools

Microsoft Office applications

Database management

Job description

About the job

Duties and Responsibilities:

Claims Processing Oversight

• Support the Manager in supervising daily claims / batch intake, validation, adjudication, and settlement activities.
• Ensure compliance with Nphies e-claims standards, coding standards, MDS and timeline specified per regulations.
• Monitor turnaround times (TAT) to meet internal and external service-level agreements (SLAs).

Quality Assurance & Compliance

• Assist in implementing internal controls to ensure claims accuracy and prevent fraud, waste, and abuse.
• Coordinate with internal audit and compliance teams to maintain adherence to CCHI guidelines and regulatory directives.
• Contribute to training programs for staff and providers on correct claims submission and reconciliation processes.

Discrepancy Resolution

• Oversee investigation of claim discrepancies, rejections, and denials, and ensure timely resolution.
• Support communication with healthcare providers, external and internal teams / stakeholders to address recurring issues.
• Escalate unresolved or high-impact discrepancies to the Senior Claims Manager with recommended solutions.

Stakeholder Management

• Act as deputy contact point for healthcare providers, external and internal stakeholders and claims staff.
• Provide guidance to healthcare providers on claims processing requirements and Nphies compliance.
• Participate in regular meetings with hospitals, clinics, and pharmacies to strengthen provider relations.

Reporting & Continuous Improvement

• Prepare operational dashboards and performance reports for management review.
• Support process re‑engineering projects to reduce rejections and enhance claims accuracy.

People Management & Performance

This role is critical for the day‑to‑day leadership and performance development of the claims processing team, which is vital for a Tier 1 insurance company's operational excellence.

• Team Oversight & Support: Supports the Manager in supervising daily claims intake, validation, adjudication, and settlement activities.
• Training & Development: Contribute to training programs for staff and providers on correct claims submission and reconciliation processes.
• Performance Management (Tactical): Oversee investigation of claim discrepancies, rejections, and denials, and ensure timely resolution. Identify trends in denials and contribute to corrective action plans.
• Risk & Compliance Culture: Acts with due diligence to safeguard company interests. Maintain highest level of confidentiality.

Skills

Education

Bachelor’s degree in Medicine / Pharmacy, Healthcare Administration, Business Administration or Health Informatics.

Experience

• Hands‑on experience in Medical Claims Processing domain (3–5 years minimum)
• Healthcare Insurance & Regulatory Compliance (5+ years preferred)
• Understanding of Medical Claims Processing

Personal Attributes / Skills

• Integrity & Ethical Mindset – Strong moral principles to handle sensitive financial and healthcare data responsibly.
• Attention to Detail – Ability to spot anomalies, inconsistencies, and patterns in data.
• Analytical Thinking – Logical approach to problem‑solving and decision‑making.
• Critical Thinking – Evaluating evidence to determine fraud risks and compliance gaps.
• Persistence & Patience – Fraud investigations and reconciliations can be complex and time‑consuming.
• Communication Skills – Clear reporting of findings to internal teams, auditors, and regulators.
• Confidentiality & Discretion – Handling sensitive patient and financial information with care.
• Adaptability – Keeping up with evolving fraud schemes and regulatory changes.

Others

• Fluency in Arabic language, working knowledge of the English language is an advantage.
• Proficiency in using Microsoft Office applications and database management.
• Ability to work independently and as part of a team to achieve network management goals.