Job Description

Roles & Responsibilities

The Claims Submission & Resubmission Officer is responsible for preparing, submitting, and monitoring medical claims to insurance companies to ensure accurate and timely reimbursement for hospital services. Responsibilities Managerial Coordinate with relevant teams to ensure smooth insurance claims processing and workflow efficiency Support communication between billing, coding, and insurance departments Technical Prepare and submit insurance claims for hospital services, ensuring accuracy in coding and patient information Verify patient insurance eligibility and coverage prior to claim submission Collaborate with billing and coding teams to ensure claims meet payer requirements Monitor claim submission status and follow up on pending or unprocessed claims Respond to insurance provider queries related to claim details Maintain accurate records of submitted claims and their status updates Stay updated with insurance policies, regulations, and claim submission protocols Quality and Safety Promote and maintain quality standards and support continuous quality improvement initiatives Comply with safety, infection control, and quality control policies and procedures Ensure adherence to environmental safety and infection prevention practices Support clinical audit processes and reporting requirements Communicate professionally with patients, families, and healthcare staff to obtain or clarify required information Ensure documentation accuracy and compliance with hospital standards Continuous Education Participate in training sessions for staff, doctors, and nurses on equipment handling and related processes Attend departmental programs, hospital committees, and staff meetings when required Support orientation and training of new employees Maintain professional knowledge through lectures, seminars, and online learning Complete all required licensing, certification, and mandatory training within deadlines Apply knowledge of relevant sciences such as anatomy, physiology, and related technical fields Occupational Safety and Health (OSH) Comply with all OSH and infection control policies, standards, and procedures Report OSH hazards, incidents, near misses, and assist in risk assessments Participate in OSH and infection control training, drills, and awareness programs Follow safe working procedures and use appropriate personal protective equipment (PPE) Adhere to emergency and evacuation procedures Ensure proper waste management practices (reduce, reuse, recycle) Participate in OSH audits and inspections to maintain standards Prevention and Control of Infection (PCI) Adhere to NMC PCI Policy and Strategy at all times Maintain strict hand hygiene practices, including the 5 moments of hand hygiene Follow “bare below the elbows” and environmental cleanliness standards

Desired Candidate Profile

Bachelor’s degree in Healthcare Administration, Nursing, Paramedical, or a related field Knowledge of medical coding, billing processes, and insurance claim management Proficiency in hospital management systems and claims submission software Strong organizational skills with excellent attention to detail Excellent communication and problem-solving abilities Experience Relevant experience in healthcare administration, insurance claims, billing, or related functions (as applicable to role requirements) Specialist Certification Required: NA Desired: NA Additional Requirements Self-motivated and able to work under pressure Fluent spoken and written English (Arabic is advantageous but not mandatory) Supportive, caring, and professional disposition Strong adaptability and time management skills Confidence in handling stressful situations Strong IT competencies and computer literacy