Medical Insurance Claims Specialist

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

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.