Claims Officer

1 month ago


Dubai, United Arab Emirates TPA Full time

**1.** **JOB PURPOSE**

The Jobholder serves providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests and maintaining database. He / She should provide accurate and relevant medical coverage details, maintain pre-approvals and claims processing and adjudication cycle within NHS software systems as per the defined terms and policies of the organization; He/ She will be guided by the regulations laid down by the regulatory authorities such as MOH, DHA or others.

**2.** **RESPONSIBILITIES AND DUTIES**
- To issue online and verbal authorizations based upon member coverage & medical justification.
- To maintain files for authorizations and other reports.
- Assessing and processing claims in line with the policy coverage and medical necessity.
- Be fully versed with medical insurance policies for various groups / beneficiaries.
- Might be required to assist in training colleagues and sharing knowledge.
- Able to accurately assess eligibility within the UAE (HAAD and DHA) guidelines as well as policy boundaries.
- Monitoring and maintaining the claims processing and adjudicating cycle in NHS operational software system as per the defined terms and policy of the organization.
- Establishing strategies and implementing effective parameters for solving all possible queries within the team.
- Taking a lead role in assuring that the assigned tasks to the team are completed within the allocated time frame.
- Ensures the proper communication and implementation of new formats, training and processing rules.
- Entering and processing/ adjudicating claims in NHS operational software system as per the terms and policy of the organization.
- Taking initiatives to maximize team efficiency.
- Maintaining both qualitative and quantitative claims measures.
- Ensure adherence to the predefined TATs for claims and pre-approvals
- Achieving required processing targets assigned by the team leader on daily, weekly and monthly basis.
- Monitor the qualitative and quantitative measures for claims & pre-approvals.
- Ensure compliance to any changes in terms of system parameters or process.

**3.** **KNOWLEDGE, SKILLS AND EXPERIENCE**
- University degree in any discipline of Medical/Para-medical specialization from a reputable university.
- Healthcare/Hospital experience for 1-2 years, in departments such as Surgery, ICU or GP, is required.
- 1 - 2 years of work experience in the Insurance industry is preferable but not mandatory.
- Excellent oral and written communication skills.
- Must be computer literate.
- Excellent command of the English language, Arabic is a definite plus.
- Should be a team player with an aptitude for customer service. Must be service oriented.
- Highly decisive with outstanding logic and reasoning skills.
- Ability to work under pressure and meet tight deadlines and varying work-schedules.

**Job Types**: Full-time, Permanent

Pay: AED6,000.00 - AED6,500.00 per month

**Education**:

- Bachelor's (preferred)

**Experience**:

- Insurance: 1 year (preferred)
- Hospital: 1 year (preferred)


  • Claims Officer

    3 weeks ago


    Dubai, United Arab Emirates TPA Full time

    A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company. - Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information. - In addition, a processor must keep meticulous records of claims and follow up on lapsed cases. - Medical claims processors...


  • Dubai, United Arab Emirates Dubai Limited Investment Full time

    We are immediately hiring a Medical Claims Officer for our TPA Almadallah Healthcare Must have 5+ years experience in Medical Insurance/TPA experience as a Medical Claims Officer Qualification-MBBS (mandatory) Salary-8000-9000 AED/month Preference for immediate joiners Pay: AED9,000.00 - AED10,000.00 per month **Experience**: - TPA/Insurance: 1 year...


  • Dubai, United Arab Emirates Dubai Limited Investment Full time

    We are immediately hiring a Medical Claims Officer for our TPA Almadallah Healthcare Must have 5+ years experience in Medical Insurance/TPA experience as a Medical Claims Officer Qualification-MBBS (mandatory) Salary-8000-9000 AED/month Preference for immediate joiners Pay: AED8,000.00 - AED9,000.00 per month Application Question(s): - Do you have...

  • Claims Officer

    2 weeks ago


    Dubai, United Arab Emirates Allianz Partners Full time

    **JOB DETAILS** The role of Claims Officer involves processing medical claims for clients worldwide. We ensure a high level of client service while processing claims within an industry leading 48 hours. The Claims Department is a very fast paced and challenging environment, with many different languages used and a mixture of cultures. **KEY...


  • Dubai, Dubai, United Arab Emirates Allianz Partners Full time

    Medical Claims Senior Claims Officer | Allianz Partners DubaiAllianz Partners is a world leader in B2B2C insurance and assistance, offering global solutions that span international health and life, travel insurance, automotive and assistance. Customer driven, our innovative experts are redefining insurance services by delivering future-ready, high-tech...


  • Dubai, United Arab Emirates Alliance Insurance P.S.C Full time

    A leading insurance company is looking for Life Insurance Claims Officer to ensures delivery of efficient claim services to insured clients. **Role & Responsibilities**: - Responsible for evaluating group and individual life claims. Utilize in-depth knowledge of risk factors, market trends, and regulatory practices to evaluate the validity of claims. -...


  • Dubai, Dubai, United Arab Emirates Allianz Partners Full time

    SummaryThe Precertification Officer is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers with high efficiency and within the agreed turnaround time to maintain the team KPIs.Main Tasks Assesses approval of medical approvals as well as policy use. Checks...


  • Dubai, United Arab Emirates Allianz Partners Full time

    **Summary** The Claims officer provides quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards. **Main Tasks** - Evaluates medical claims from the technical and medical perspectives as per policy terms and conditions. - Checks particular treatment plan is necessary for the...


  • Dubai, United Arab Emirates Allianz Partners Full time

    **Summary** The Claims officer provides quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards. **Main Tasks** - Evaluates medical claims from the technical and medical perspectives as per policy terms and conditions. - Checks particular treatment plan is necessary for the...


  • Dubai, United Arab Emirates Commercial Insurance Brokerage Services LLC Full time

    Our company Commercial Insurance Brokerage Services is looking to hire a Medical Claims Officer to join our technical team in Dubai. Reporting to the General Manger the incumbent will be responsible for the entire medical underwriting process through a variety of technical tasks. **Responsibilities** - Evaluates and processes claims in accordance with...


  • Dubai, United Arab Emirates TPA Full time

    A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company. - Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information. - In addition, a processor must keep meticulous records of claims and follow up on lapsed cases. - Medical claims processors...


  • Dubai, United Arab Emirates TPA Full time

    A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company. - Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information. - In addition, a processor must keep meticulous records of claims and follow up on lapsed cases. - Medical claims processors...

  • Claims Officer

    5 days ago


    Dubai, Dubai, United Arab Emirates TPA Full time

    1. JOB PURPOSETHE JOBHOLDER SERVES PROVIDERS AND INSURANCE COMPANIES BY DETERMINING REQUIREMENTS, ANSWERING INQUIRIES, RESOLVING PROBLEMS, FULFILLING REQUESTS AND MAINTAINING DATABASE. HE / SHE SHOULD PROVIDE ACCURATE AND RELEVANT MEDICAL COVERAGE DETAILS, MAINTAIN REIMBUSEMENT CLAIMS PROCESSING AND ADJUDICATION CYCLE WITHIN NHS SOFTWARE SYSTEMS AS PER THE...


  • Dubai, United Arab Emirates TASCoutsourcing Full time

    Examine claims records and forms to determine whether the patient has medical insurance. - Review provisions of certificate or policy to determine the patient’s included medical coverage losses. - Negotiate claim settlements and make recommendations for legal action when settlements are deemed non-negotiable. - Complete logs, reports, forms and records to...


  • Dubai, United Arab Emirates Allianz Partners Full time

    **Summary** The Precertification Officer is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers with high efficiency and within the agreed turnaround time to maintain the team KPIs. **Main Tasks** - Assesses approval of medical approvals as well as policy...


  • dubai, United Arab Emirates Allianz Popular SL. Full time

    Press Tab to Move to Skip to Content LinkSelect how often (in days) to receive an alert:Select how often (in days) to receive an alert:Employing Entity:NEXTCARE Claims Management LLCJob Type:Full-TimeRemote Job:Not applicableEmployment Type:PermanentID:39326SUMMARYThe Senior Medical Claims - Officer will provide quality service to clients, promptly and...


  • dubai, United Arab Emirates Allianz Popular SL. Full time

    The Senior 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.• Evaluates claims with regards to eligibility.• Takes decisions on high cost and complicated cases based on...


  • dubai, United Arab Emirates Allianz Popular SL. Full time

    The Senior 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.• Evaluates claims with regards to eligibility.• Takes decisions on high cost and complicated cases based on...

  • Medical Claims Officer

    2 months ago


    Dubai, United Arab Emirates Allianz Partners Full time

    **SUMMARY** The Senior 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...


  • dubai, United Arab Emirates Allianz Partners Full time

    Medical Claims Senior Claims Officer | Allianz Partners DubaiAllianz Partners is a world leader in B2B2C insurance and assistance, offering global solutions that span international health and life, travel insurance, automotive and assistance. Customer driven, our innovative experts are redefining insurance services by delivering future-ready, high-tech...