Transguard Workforce Solutions is the UAE’s leading provider of unique and innovative HR solutions. With a decade of experience in the region and a team that possesses extensive knowledge of the market, we provide a fully integrated HR solution. We are currently recruiting a Senior Officer E-Claims for our client based in Abu Dhabi, UAE.
Job Purpose:The job holder is responsible for receiving and reviewing medical claims as assigned by the supervisor, ensuring timely and accurate processing in line with insurance policies, company standards, and regulatory guidelines. They are also expected to handle walk-in customers professionally, providing clear and satisfactory responses. Within their delegated authority, they must process claims with diligence and accountability, while identifying and escalating any suspicious patterns or potential abuse by providers to the supervisor.
Job Description:Reviewing claims for medical necessity, coding accuracy (ICD, CPT, CDT), and compliance with pre-authorization and tariff agreements. Approving or rejecting claims within delegated authority, with proper documentation and denial codes. Escalating suspicious or invalid claims to supervisors. Ensuring adherence to SLAs, audit standards, and continuous process improvement. Generating reports and contributing to policy updates and cost containment initiatives.
Job Requirements:Degree in Medicine, Dentistry, Pharmacy, Nursing, or Paramedics CPC/AHIMA certification preferred3-5 years of relevant experience in the UAE required. Proficient in English and medical coding standards