52 Medical Claims jobs in the United Arab Emirates

Overview

• The role of the Senior Medical Claims Officer is to provide quality service to clients by promptly and effectively assessing and processing claims and approvals according to operational standards.

• Assess approval of medical approvals as well as policy use.
• Channel Medical Claims officers in handling difficult medical cases and optimize the quality and quantity output.
• Monitor daily output on the number of cases done and decrease in the number of errors committed.
• Check if particular treatment plans are necessary for patients.
• Input verbal and written claims approvals regularly.
• Provide second opinions for cases where there is doubt in treatment plans.
• Decide approvals as per policy conditions.
• Assess high-cost claims and provide decisions on high-cost and complicated cases.
• Provide clear feedback on queries from call centre teams.
• Explain declined medical claims to clients.
• Manage routine daily claims administration work.
• Coordinate workflow and meet deadlines.
• Evaluate claims with regards to eligibility.
• Provide on-the-job training to team members as necessary.

• Bachelor's degree in Medicine, Pharmacy, or Dentistry.
• Minimum 2 years of medical practical experience (reputable insurance provider, broker, or TPA experience a plus).
• Physically fit to carry out duties.
• Licensed to work in the country of operations.
• Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.

• Mid-senior level position.
• Full-time employment.
• Finance and sales job function.
• Financial services and insurance industry.

Analyzes claims and decides whether they are covered by policy.

Makes recommendations for the settlement of claims.

Informs clients if claims are accepted and how they will be allocated.

Organizes payments to clients and repair or replacement of lost items.

Makes sure all inquiries and payments are dealt with quickly.

Appoints insurance loss adjusters and private investigators when required.

Contacts independent experts in case of disputes and attends disputes tribunals.

Obtaining approvals for medical procedures.

Works closely with insurance companies/TPAs.

Communicates and follows up with insurance companies.

Explains clients about policy coverage.

Any complaint received from DHA to be attended to within one hour on the same day.

All reimbursement claims to be submitted after due verification on the same day to insurers.

Medical Claims Specialist Job Description

The Medical Claims Specialist is responsible for examining claims and determining whether they fall within policy coverage.

This role involves making recommendations for claim resolution, informing clients about accepted claims and their allocations, and coordinating payments to clients for the repair or replacement of lost items.

In addition, this position requires expediting all inquiries and payments, designating insurance loss adjusters and private investigators when necessary, contacting independent experts in case of disputes, and attending dispute tribunals.

The Medical Claims Specialist works closely with insurance companies and TPAs, communicates with them, and explains policy coverage to clients.

Maintaining high standards of customer service is crucial in this role, with prompt attention given to any client complaint received within one hour on the same day.

All reimbursement claims must be verified and submitted to insurers on the same day.

This role demands strong analytical and communication skills, with a focus on delivering exceptional customer service and ensuring timely claim resolutions.

Key Responsibilities:

• Analyzing claims to determine policy coverage
• Examining claims data to make informed decisions
• Communicating with clients and insurance companies
• Coordinating claim settlements and payments
• Designating insurance loss adjusters and private investigators
• Attending dispute tribunals

Benefits:

• Promoting excellent customer service standards
• Fostering a collaborative work environment
• Providing opportunities for professional growth and development

Role Overview:

The Insurance Coordinator plays a vital role in ensuring the smooth operation of insurance-related tasks within our organization.

Responsibilities include:

1. Handling medical insurance claims and ensuring compliance with guidelines.
2. Maintaining relationships with insurance companies and assisting clients in understanding their insurance coverage.
3. Processing insurance claims for the sale and rental of medical equipment, ensuring timely submission and follow-up on payments.
4. Liaising with insurance companies to resolve claim disputes or delays.
5. Providing detailed records of insurance claims and customer interactions.

Requirements:

• Excellent communication and organizational skills.
• Ability to work accurately and efficiently under pressure.
• Strong analytical and problem-solving skills.
• Proficiency in maintaining accurate records and files.

What We Offer:

• A dynamic and supportive work environment.
• Ongoing training and development opportunities.
• A competitive salary and benefits package.

If you are a detail-oriented professional with a passion for delivering exceptional results, we encourage you to apply for this exciting opportunity.

Senior Medical Claims Officer provides quality service to clients by promptly and effectively assessing and processing claims and approvals according to operational standards.

The role also involves ensuring team success by setting, implementing, and monitoring individual and team objectives, while adhering to company policies and procedures.

• Assess approval of medical claims and policy usage.
• Guide Medical Claims Officers in handling difficult medical cases to optimize quality and output.
• Monitor daily output and reduce errors.
• Evaluate treatment plans for necessity.
• Input verbal and written claim approvals regularly.
• Provide second opinions on cases with treatment plan doubts.
• Decide approvals based on policy conditions.
• Assess high-cost and complex claims and make decisions accordingly.
• Provide clear feedback to the Call Centre team on queries.
• Explain declined medical claims to clients.
• Manage routine claims administration tasks.
• Coordinate workflow and meet deadlines.
• Evaluate claims for eligibility.
• Provide on-the-job training to team members as needed.

• Bachelor's degree in Medicine, Pharmacy, or Dentistry.
• At least 2 years of practical medical experience, preferably with a reputable insurance provider, broker, or TPA.
• Physically fit to perform duties.
• Legally permitted to work in the country of operations.
• Proficient in MS Office (Excel, Word, Outlook, PowerPoint) and internet research skills.

Job ID: 80053 | Customer Services & Claims | Professional | Non-Executive | Allianz Partners | Full-Time | Permanent

Allianz Group is a trusted global insurance and asset management company. We value our employees' ambitions and challenges, fostering an environment of empowerment, growth, and innovation.

We are committed to diversity and inclusion, welcoming applications regardless of ethnicity, age, gender, nationality, religion, disability, or sexual orientation.

Join us and let's care for tomorrow.

Find thousands of job opportunities by signing up to eFinancialCareers today.

We are seeking a skilled Claims Administrator to record medical claims for clients worldwide. The ideal candidate will ensure high levels of customer service while registering claims within our agreed service level standards.

• The role involves preparing, scanning, and registering incoming claims received by post and email to achieve daily clear targets.
• Data entry is required to optimize claims adjudication and meet departmental Service Level Agreements.
• Collation and posting of claims letters are necessary to notify clients of their claim settlement.
• Liaising with other departments for support ensures an efficient and professional response, thereby achieving customer satisfaction.
• Supporting other units with administration duties is also a key aspect of the role.
• Maintaining accurate filing records allows files to be located quickly, ensuring customer queries can be dealt with efficiently.
• Resending unsuccessful emails notifies customers of the status of their claim.

• A minimum of 1-2 years of administration experience is essential.
• A medical background and coding knowledge would be advantageous.
• Proficiency in MS Office/Excel/PowerPoint is required.
• Candidates must possess strong interpersonal and communicative skills.
• Excellent attention to detail and the ability to work under pressure are also necessary.
• Team players who can meet tight deadlines and service standards are highly valued.

We are seeking an experienced Medical Claims Professional to join our team.

This role involves providing quality service to clients by assessing and processing claims in accordance with operational standards.

• Evaluate medical claims and make decisions based on policy conditions.
• Assess high-cost and complex claims, ensuring accurate approvals.
• Guide team members in handling difficult cases to optimize quality and output.
• Monitor daily output, reducing errors and improving efficiency.
• Evaluate treatment plans for necessity and provide second opinions when required.
• Provide clear feedback to colleagues on queries and explain declined claims to clients.
• Manage routine claims administration tasks, ensuring timely completion.
• Coordinate workflow and meet deadlines, prioritizing tasks as needed.
• Evaluate claims for eligibility and provide on-the-job training to team members.

• Bachelor's degree in Medicine, Pharmacy, or Dentistry.
• At least 2 years of practical medical experience, preferably with a reputable insurance provider, broker, or TPA.
• Physically fit to perform duties and legally permitted to work in the country of operations.
• Proficient in MS Office (Excel, Word, Outlook, PowerPoint) and internet research skills.

The successful candidate will be part of a dynamic team, fostering growth and innovation. We value diversity and inclusion, welcoming applications from individuals with varying backgrounds and experiences.

Benefits:

• A competitive salary and benefits package.
• Ongoing professional development opportunities.
• A collaborative and supportive work environment.

We look forward to receiving your application!

SUMMARY The Medical Claims Officer will provide quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards.

MAIN TASKS

• Manages routine daily claims administration work.

• Coordinates work flow & meet deadlines.

• Evaluates claims with regards to eligibility.

• Takes decisions on high cost and complicated cases based on standard operating procedures.

• Handles International Preauthorization cases as required.

• Attends calls and e-mails from insurance companies, clients, and providers.

• Coordinates with international providers for direct billing.

• Makes suggestions to improve service.

• Increases efficiency, minimizes errors and administration time.

BEHAVIORAL REQUIREMENTS

• Organizational & time management skills.

• Excellent team player.

• Ability to work well with all levels of internal management and staff, as well as outside clients and users.

• Ability to demonstrate sound work ethics.

• Show flexibility with excellent interpersonal skills.

• The ability to communicate sensitively and effectively with claims department and other departments having regard for the strict need for confidentiality.

• To be capable of responding diplomatically to pressures and problems showing a calm approach to working towards deadlines and always able to show an innovative and creative approach to work.

• The ability to exercise initiatives and be able to work flexibly under pressure and to tight deadlines.

• Experience of working with senior managers and understanding the necessity to act in a pleasant and courteous manner and to be able to work effectively with others.

BEHAVIORAL COMPETENCY Customer & Market Excellence:

• Strive for excellence at every touch point with the customer

• Foster state-of-art technical/operational knowledge and strive for continuous simplification

• Be the benchmark Collaborative Leadership:

• Empower the team and provide purpose and direction

• Develop people, provide feedback and care to employee wellbeing

• Collaborate and exchange best practice. Entrepreneurship:

• Act on opportunities, anticipate trends, take risk, and promote a culture that allows for honest failure

• Take ownership and responsibility

• Embrace innovation and a culture that allows to make decisions without fear of retribution. Trust:

• Act with integrity, honor commitments, tell the truth

• Foster diversity and inclusiveness

• Act transparently and promote corporate social responsibility.

MINIMUM REQUIREMENTS

• Bachelor's of Medicine (MBBS) only.

• Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus).

• Physically fit to carry out duties.

• Legally permitted to work in the country of operations.

• Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills

44265 | Operations | Professional | ((custPositionClusterCSB)) | Allianz Partners | Full-Time | PermanentAllianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams and challenges, is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow and to shape a better future for our customers and the world around us. We at Allianz believe in a diverse and inclusive workforce and are proud to be an equal opportunity employer. We encourage you to bring your whole self to work, no matter where you are from, what you look like, who you love or what you believe in. We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, disability or sexual orientation. Great to have you on board. Let's care for tomorrow.

We are seeking a dedicated and experienced professional to fill the role of Approval Specialist. In this position, you will be responsible for ensuring that pre-authorization requests meet the required standards and regulations.

• You will review and verify pre-approval requests received from different departments, ensuring that they align with insurance company requirements and plan coverage.
• You will evaluate pre-approval requests based on medical necessity and accurately code service descriptions according to accepted medical coding rules and guidelines.
• You will respond to insurance/TPA queries in a timely manner and liaise with concerned departments without delay.
• You will receive, evaluate, and escalate second opinion cases and case management as needed.
• You will perform night shift duty and work on public holidays as per duty roster.
• You will prepare reports of daily activity as requested by management and assist in monthly reports.
• You will handle auditing processes, arranging necessary documents and papers, and collaborating with coders to support external auditors.
• You will attend meetings and presentations, providing updates and insights as required.
• You will train front office staff, receptionists, and nurses on insurance details and best practices.
• You will prepare cost estimates for procedures and adjust duties as needed in case of sudden or emergency unplanned leaves by colleagues.
• You will manage and handle pending cases, transferring tasks to the next shift colleague as necessary.

Qualifications:

• Bachelor's degree in Medicine (MBBS) from a recognized university.
• Minimum 2 years of experience in insurance claims management/adjudication.
• Proven expertise in medical coding (ICD, CPT, DRG, HCPCS).
• Excellent command of oral and written English.
• Flexible and able to work under pressure.
• Proficiency in Microsoft applications.