Medical Insurance Senior Specialist📣 إعلان

About the Role

This full-time position is for a Medical Insurance Senior Specialist based in Riyadh, Saudi Arabia. The role involves leading and managing critical processes related to medical approvals, insurance claims, and billing with insurance companies and corporate sales accounts. The primary objective is to enhance polyclinic profitability by minimizing claim rejections and ensuring timely payment collection.

Key Responsibilities

• Manage and oversee the medical approvals, insurance claiming, and billing processes.
• Work towards obtaining instant approvals for insurance guests and analyze daily data to improve claiming processes and operations.
• Review and verify insurance claims, ensuring all required data and information are accurate.
• Cross-reference and verify reports against insurance companies' systems, including Tawuniya, DHS, and Bupa.
• Communicate and negotiate with insurance companies to address and minimize claim rejections prior to reconciliation.
• Review patient records utilizing medical coding procedures and detect or correct any coding errors.
• Examine claims, verify insurance eligibility, and accurately record medical charges, payments, and adjustments.
• Assist patients in understanding their medical benefits.
• Liaise with other medical staff members and health insurance providers.
• Maintain and update internal databases for patient records, billing details, and registration forms.
• Collaborate with concerned departments regarding medical insurance claims and finalize processes with teams such as Finance and IT.

Experience and Qualifications

The ideal candidate will possess 2-5 years of relevant experience in medical insurance processing, claims management, or a related field. A strong understanding of medical coding procedures and experience with insurance verification systems is required. The ability to communicate effectively with insurance providers and internal stakeholders is essential.

Work Environment and Schedule

This role operates entirely indoors within a 6-day work week, with one day off. Working hours consist of 8-hour shifts, including a 1-hour rotating break, to ensure continuous coverage. The position is based in Riyadh.