Insurance Administrative

Job Description

Serves medical insurance customers by determining insurance coverage; examining and resolving medical claims; documenting actions; ensuring legal compliance.

Primary Responsibilities:

• Evaluation of the requests (investigations and medications) medically and coverage according to the Basic CCHI policy and patient insurance Table of Benefits (TOB).
• Handling the submission of requests through NPHIES and/or different insurance companies’ portal within specific time
• Follow up the reply from the insurance companies.
• Communicate with My Clinic medical team for justification if required.
• Communicate with My Clinic operation teams (Reception and customer service) the insurance companies` decisions.
• Preparation of tracker for the abnormal trend (investigations and medications) of the doctors to be helpful in awareness sessions with the doctors to decrease the medical rejection.
• A doubting for the flexible timing
• Accountability and responsibility on wrong Policy decision.

Education / Professional Qualifications:

• Degree educated in Medical/business related subjects.

Experts & Skills:

• Excellent Command of oral and written English & Arabic.
• Proficient with Microsoft Office Suite or related software .
• Details oriented.
• Excellent communication skills.
• Excellent problem-solving skills and the ability to strategize and devise solutions.
• Outstanding analytical mindset and comfort working with numbers.
• Good Team Worker
• Good communication skills dealing with both internal and external customers.