General Overview:
We are hiring a Medical Claims Officer for our client, a well-established organization within the healthcare insurance sector. This role supports the medical claims function by ensuring accurate, timely, and compliant processing of health insurance claims in line with policy terms, internal guidelines, and regulatory requirements.
The position is ideal for a detail-oriented professional who is eager to grow within medical claims and healthcare administration while contributing to efficient service delivery and claims quality.
Key Responsibilities:
Review, assess, and process medical insurance claims, including inpatient, outpatient, and reimbursement claims. Verify claim documentation such as invoices, medical reports, prescriptions, and prior approvals. Ensure all claims are processed in compliance with policy coverage, company procedures, and DHA / DOH regulations. Accurately enter and update claims data within the claims management system. Coordinate with healthcare providers, TPAs, and internal teams to obtain missing or additional information. Escalate complex, high-value, or suspicious claims to senior officers or supervisors for further review. Support fraud prevention efforts by identifying and flagging unusual or inconsistent claim patterns. Maintain proper documentation and records for audit, compliance, and reporting purposes. Meet defined turnaround time (TAT) and service level standards.
Key Requirements:
UAE Nationa I with Family Book – mandatory.1–2 years of experience in medical claims, healthcare administration, or insurance (preferred). High School, Diploma, or bachelor’s degree. Basic understanding of medical insurance claims processes and healthcare terminology. Strong attention to detail and accuracy. Good communication skills and ability to coordinate with multiple stakeholders. Ability to work efficiently in a structured, process-driven environment.