Job Description

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 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.

Minimum Qualifications:

• Medicine Bachelor’s degree (MBBS).
• Licensed by the Saudi Commission for Health Specialties (SCFHS).