Medical Insurance Senior Specialist

Nahdi Medical Co.; Riyadh; On-site; SAR 40,000 - 60,000; Full time

Job summary

A leading healthcare organization in Riyadh seeks a candidate for managing medical insurance approvals and billing processes. The role includes communicating with insurance companies to resolve claim rejections and ensuring the accuracy of patient records. Ideal candidates should possess at least 2 years of medical insurance experience and be fluent in both English and Arabic. This position requires strong analytical and communication skills, with a commitment to enhancing profitability and efficiency in healthcare services.

Qualifications

• Minimum 2 years of experience in Medical Insurance.
• Fluent in English and Arabic, both spoken and written.

Responsibilities

• Lead and manage medical approvals and billing processes.
• Analyze data to improve claiming process.
• Communicate with insurance companies regarding claim rejections.
• Verify claims against insurance systems and processes.
• Maintain accurate patient and billing records.

Skills

Medical Insurance Management

Data Analysis

Claim Verification

Communication Skills

Problem-solving

Education

High School Diploma (Preferably University Graduate)

Tools

Microsoft Office

Job description

Job Description

This role will be leading and managing the medical approvals, insurance claiming and billing process with insurance companies and credit corporate sales accounts. Also working to minimize the rejections and collect payments within due dates to improve polyclinic profitability.

Accountabilities

• Medical Insurance Head Working on instant approvals for insurance guests, analyzing day to day data in order to improve the claiming process and operations.
• Reviewing and verifying the claims and all the required data/information.
• Verifying and checking the reports matching with “waseel” insurance companies’ systems (Tawuniya, DHS and Bupa).
• Communicating and negotiating with insurance companies in case of claims rejections to minimize it before reconciliations.
• Experience with healthcare provider in insurance will be an added point.
• Reviewing patient records using medical coding procedures.
• Examine claims, verify insurance eligibility, and record any medical charges and other payments or adjustments.
• Detecting any coding errors or performing any modifications needed.
• Assisting patients in obtaining and understanding medical benefits.
• Communication with other medical staff members and health insurance providers often occurs.
• Responsible for updating any internal databases, which electronically store and organize patients’ records, billing details, and registration forms.
• Liaise with concerned departments on their medical insurance claims and finalize it with other teams (Finance, IT..etc)
• Employee’s duties are not limited only to the above-mentioned Accountabilities; he/she may perform other duties as assigned.

Work Environment

• Indoors : 100%
• Outdoors : 0%
• Working Days : 6 Working Days
• Days off : 1 Day Off
• Working Hours : 8 hours Shifts to ensure continuous attendance to reception. (with 1 hour Rota break)

Job Requirement

Education

• High School Diploma (Preferably University Graduate)

Experience

• 2 years in Medical Insurance

Computer Skills

• Microsoft Office

Languages

• English and Arabic (fluent spoken and written)