#Hiring Medical Claims Processing Specialist for our Insurance Domain Client in Riyadh.
Process all (Direct Billing and RI claims) the daily batches of claims assigned in line with medical policy and Inpatient adjudication guidelines while using medical background in conjunction with the instructed guidelines, day-in-day-out for smooth operation of business activity.
Achieve daily target in terms of number of claims processed within the defined regulatory timeframe.
Ensure that the claims are paid as per the eligible benefit and coverage.
Discusses all high profile/high value claims with the claims medical manager/TL where the decision is difficult & well thought.
Monitor and record the medical abuse and refer the suspected fraud claims to the Audit and investigation team.
Monitor the prices and calculation discrepancies while processing the claims and report the claims which are over invoiced and or have unagreed service codes to the relevant Network team.
Apply the medical skills and expertise to apply the rejections wherever is applicable.
Assist in additional tasks whenever assigned by the claims Manager/TL
Kindly send CVs to [Click to show email]