SENIOR MEDICAL CLAIMS ANALYST.

Johns Hopkins Aramco Healthcare; Saudi Arabia; On-site; SAR 200,000 - 300,000; Full time

Job summary

A leading healthcare organization in Saudi Arabia seeks a dedicated professional to oversee quality audit initiatives and mentor junior staff in claims processing. The role involves leading audits, resolving disputes, and contributing to policy refinement. Candidates should have a bachelor's degree in a relevant field and 4-6 years of progressive experience in healthcare or insurance. A preferred professional certification is a plus.

Qualifications

• Bachelor degree in healthcare administration, business, or related field.
• 4-6 years of progressive claims processing experience in healthcare or insurance.
• Professional certification (e.g., CPC, CPB) preferred.

Responsibilities

• Lead quality audit initiatives and implement corrective actions.
• Contribute to policy refinement based on claim pattern analysis.
• Mentor and develop junior staff capabilities.
• Resolve escalated provider disputes involving moderate-complexity clinical determinations.
• Maintain expertise in regulatory changes and industry best practices.

Job description

Overview

Quality-focused role owning team-level accuracy and complex case resolution. Responsible for leading quality initiatives, resolving escalated disputes, and mentoring junior staff while contributing to policy refinement.

Strategic Roles & Responsibilities

Strategic %: 10%

• Lead quality audit initiatives and implement corrective actions
• Contribute to policy refinement based on claim pattern analysis
• Mentor and develop junior staff capabilities

Operational Roles & Responsibilities

Operational %: 90%

• Lead quality audits for the claims team, analyzing root causes of errors
• Implement corrective actions to reduce claim processing errors
• Resolve escalated provider disputes involving moderate-complexity clinical determinations
• Develop claim review checklists for high-frequency scenarios using trend data
• Update and refine policies based on claim pattern analysis
• Mentor junior staff on policy interpretation and dispute resolution
• Conduct training sessions on complex claim scenarios
• Maintain expertise in regulatory changes and industry best practices

Qualifications

Bachelor degree in healthcare administration, business, or related field

Professional Certifications Required

Professional certification (e.g., CPC, CPB) preferred

Years of Experience

4-6 years of progressive claims processing experience in healthcare or insurance

Languages

• Accounts Receivable
• Billing Investigations

Core Competencies

• Integrity
• Accountability
• Cybersecurity
• Person-Centered Care

Acknowledgement

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Supplemental Work/Experience/Education Information