Medical Claims Review Officer

About SAICO Insurance

SAICO Insurance is seeking a Medical Claims Review Officer to join their team in Riyadh, Saudi Arabia. This is a full-time position requiring 0-1 years of experience, focusing on the accurate evaluation and processing of medical claims.

Role Overview

The Medical Claims Review Officer is responsible for ensuring the clinical accuracy and compliance of medical claims with established policy guidelines and regulatory standards. This role involves detailed review of medical documentation and direct communication with healthcare providers to facilitate efficient claims management.

Key Responsibilities

• Evaluate and verify medical claims to ensure clinical accuracy and compliance with policy guidelines and regulatory standards.
• Review patient records, medical reports, and supporting documentation to facilitate accurate claim evaluation and processing.
• Provide healthcare providers with medical justifications for rejected claims in line with international and Saudi medical guidelines.
• Negotiate and resolve disputed claims directly with healthcare providers when required.
• Achieve daily claims targets as assigned by the Claims Manager, approved by the Head of Medical.
• Collaborate with other departments to verify claim amounts, status, and related information.
• Support efficient, accurate, and compliant claims management through timely decision-making and communication.

Qualifications and Experience

• Medicine Bachelor’s degree (MBBS).
• Licensed by the Saudi Commission for Health Specialties (SCFHS).
• 0-1 years of relevant experience.

Work Environment

This is a full-time position based in Riyadh, Saudi Arabia, offering an opportunity to contribute to a structured claims management process within the insurance sector.