Claims Officer
5 months ago
**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)
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