Job Description

NGI
الشركة الوطنية للتامينات العامة (ش.م.ع.)
NATIONAL GENERAL INSURANCE CO. (P)SC)
WE ARE HIRING!
MEDICAL CLAIMS SUPERVISOR
JOB LOCATION – HEAD OFFICE

• JOB DUTIES
• Responsible for the screening of claims to ensure cost containment, medical necessity, and check for fraudulent activity.
• Screen all claims (e-claims and paper claims) in a proper and aggressive manner for all hospitals, clinics and pharmacies for processors.
• Check authorization of claims, policy details and wordings, coverage limit, necessity of treatment and CPT coding at time of screening.
• Managing PBM issues.
• Screening of resubmission claims.
• Attending to reconciliation with providers.
• QUALIFICATIONS AND SKILLS REQUIRED
• Educational Attainment / Certifications – MBBS or equivalent qualification
• Years of experience- Minimum 2-3 year in TPA / Payer / Provider
• Industry Preferred- Insurance- medical claims and preauthorization.
• Up ToDate on DRG and other UAE billing rules
• Knowledge in Medical Coding
• Advanced Excel