Medical Claims Review Officer📣 Job Ad

About the Medical Claims Review Officer Role

Saudi Arabian Cooperative Insurance Company (SAICO) is seeking a qualified Medical Claims Review Officer to join their team in Riyadh. This full-time position involves the critical evaluation and adjudication of medical claims to ensure accuracy and adherence to policy guidelines.

Core Responsibilities

The Medical Claims Review Officer will be responsible for a range of duties focused on the efficient and accurate processing of medical claims. Key tasks include:

• Evaluating and verifying medical claims for clinical accuracy and compliance with policy coverage and medical guidelines.
• Reviewing patient records, medical reports, and supporting documentation to facilitate accurate claim adjudication.
• Providing healthcare providers with medical justifications for rejected claims, in line with international and Saudi medical guidelines.
• Negotiating and resolving disputed claims directly with Medical Service Providers when necessary.
• Collaborating with other departments to verify claim amounts, status, and related information.
• Supporting efficient, accurate, and compliant claims management through timely decision-making and communication.
• Achieving Key Performance Indicators (KPIs) set for the role.

Professional Development and Engagement

In addition to core claims review duties, the role requires active participation in continuous learning and company initiatives. This includes:

• Participating in Learning & Development activities, completing a minimum of 25 training hours annually to maintain up-to-date clinical, operational, and insurance knowledge.
• Contributing to Company Projects as required.

Qualifications and Experience

Candidates for this position must meet the following criteria:

• Hold a Medicine Bachelor’s degree (MBBS).
• Be licensed by the Saudi Commission for Health Specialties (SCFHS).
• Possess 2-5 years of relevant experience post-graduation in medical claims review, clinical assessment, or other healthcare-related roles.
• Demonstrate familiarity with insurance claim processes and healthcare regulations.

Essential Skills and Attributes

Successful candidates will possess a strong foundation of medical knowledge and essential professional skills, including:

• Excellent Medical Knowledge.
• Good Communication Skills.
• Strong Attention to Detail.
• Customer Orientation.
• Compliance and Ethical Awareness.
• Effective Time Management and Case Prioritization abilities.

Work Environment

This is a full-time position based in Riyadh. The role operates within the Saudi Arabian Cooperative Insurance Company (SAICO) and requires collaboration across various departments.