Insurance Administrative

About My Clinic

My Clinic is a leading multispecialty outpatient care provider in Saudi Arabia, established in 2017. The organization focuses on innovation and a commitment to care, collaboration, ambition, and responsibility, with a mission to help individuals live longer, healthier, and happier lives.

Role Overview

My Clinic is seeking an Insurance Administrative professional to join its team in Riyadh. This full-time role involves serving medical insurance customers by determining coverage, examining and resolving medical claims, documenting actions, and ensuring legal compliance. The position requires 0-1 years of experience.

Key Responsibilities

• Evaluate requests for investigations and medications based on medical necessity and coverage according to the Basic CCHI policy and patient insurance Table of Benefits (TOB).
• Manage the submission of requests through NPHIES and various insurance companies' portals within specified timeframes.
• Follow up on replies and decisions from insurance companies.
• Communicate with My Clinic's medical team to obtain justifications when required.
• Inform My Clinic's operation teams (Reception and Customer Service) about insurance companies' decisions.
• Prepare trackers for abnormal trends in investigations and medications by doctors to support awareness sessions aimed at reducing medical rejections.
• Demonstrate accountability and responsibility for policy decisions.

Qualifications and Experience

• A degree in Medical or Business-related subjects is required.
• 0-1 years of relevant experience.

Required Skills

• Ability to work effectively as part of a team.
• Strong communication skills for interacting with both internal and external customers.

Work Environment

This is a full-time position based in Riyadh, Saudi Arabia. The role involves working within a collaborative healthcare environment focused on patient care and operational efficiency.