Officer – Claims Health in الرياض الرياض السعودية

This job listing is about in الرياض الرياض السعودية 2022 exclusively on

The primary role of this position will be to audit the outpatient health claims in compliance with technical, Contractual and medical protocols, maintaining the provider profiles, facilitating the reconciliation unit with rejection data to achieved department target.

Help in maintain the departmental claims production & Claims TAT.

Key Activities, Responsibilities and Accountabilities :

  • Auditing or adjudicating the OP medical claims and play a role in maintaining the unit production
  • Finalizing the claims payment with in define period of time.
  • Profiling Health care providers and focusing billing trends of providers.
  • Work on claims rejection summery and assist in maintaining the quality of provider’s monthly statements.
  • Work on the claims data and assist in analyzing and reporting the abusive and fraudulent behaviors and billing from providers.
  • Assist in preparing the claims quality and rejections reports and help the reconciliation unit to finalize the open account and final settlement with Providers.
  • Support the departmental strategies & play a vital role in maintaining the Quality of Medical managements from provider’s side by giving regular feedback on claims and treatment quality.

Minimum Qualifications:

  • Bachelor’s Degree in Nursing, Pharmacy, Lab. Science, microbiology. Fresh Or 1 Year Experience
  • Arabic and English efficiency
  • IFCE


Vacancy Type: Full Time 

Job Location: الرياض الرياض السعودية

Application Deadline: N/A

Apply Here