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    • Provide medical guidance to the Department staff.
    • Evaluate claims (Network & Direct), provide authorizations for insured members (in-patient & outpatient) and…
    • View all Earnest Insurance Brokers LLC jobs - UAE jobs - Senior Claims Specialist jobs in UAE
    • Salary Search: Senior Claims Officer salaries in UAE
    • Visits to Clients & Insurance Companies.
    • Assistance to Accounts Department for matters of Collection.
    • Any other task as & when advised by the Management.
    • Verify the accuracy of medical coding and billing before claim submission to minimize claim denials.
    • Manage the complete medical insurance claims cycle,…
    • Experience in medical coding of 3-5 years’ within IP/OP and DRG claims.
    • Analysis and Feedback on triggers raised for OP , reimbursement claims.
    • Prepare medical records for audits, inspections, insurance claims, and legal documentation when required.
    • Verify patient information and medical documentation…
  • View similar jobs with this employer
    • Adhering to the cost containment protocols for medical management cases.
    • Requesting any medical documentation or finding any missing document which is essential…
    • Solid medical knowledge gained through training, professional experience, or a medical background.
    • Proven experience in medical claims, underwriting, or risk…
    • Maintain accurate claim records using insurance claims management systems.
    • Investigate claims and gather relevant information to support claim decisions.
    • A medical biller is responsible for submitting & resubmitting medical claims to insurance companies and payers on behalf of the hospital.
    • Review and analyze patient medical records to identify relevant diagnoses, procedures, and treatments.
    • Strong understanding of medical terminology, anatomy,…
    • University degree in any discipline of medical/Para medical science from a reputable university.
    • Internal & External Coordination · Internal § Finance: provider…
    • Ensure claims processing targets are achieved:
    • O Member claims: 95% within 5 working days.
    • O Provider claims: 95% within 20 working days.
    • Ensures to reduce rejections and get the claim paid at the initial submission of claims.
    • Proficiency in medical terminology, anatomy and physiology.
    • Coordinate second medical opinions and referrals to low-cost or home-country facilities when appropriate.
    • Perform on-site hospital visits when necessary to…
    • Review and handle claims according to the established standard procedure.
    • Ensure timely and accurate processing of approved claims for payment, including…

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Job Post Details

Senior Claims Officer - job post

Earnest Insurance Brokers LLC
UAE
AED6,000 - AED12,000 a month

Job details

Pay

  • AED6,000 - AED12,000 a month

Job type

  • Full-time

Location

UAE

Full job description

  • Supervise Claims team
  • Evaluate claims (Network & Direct), provide authorizations for insured members (in-patient & outpatient) and handle calls relating to medical cases efficiently.
  • Managing all the members approval/claims and following up with insurance companies/TPAs to get approval within the TAT.
  • Assisting our clients for reimbursement claims processes & network related issues.
  • Assess risk exposure of members in line with medical underwriting policies.
  • Manage queries from providers, Insurance Companies and insured members relating to pre-approval decisions, evaluation and administration.
  • Provide medical guidance to the Department staff.
  • Deliver excellent customer service to insured members with a view of achieving maximum client satisfaction.
  • Client Management / attending hospital visits to investigate on claims in order to minimize fraud and abuse.
  • Compile data and prepare monthly statistical reports to monitor departmental performance and medical trends.
  • Orientations for newly added clients and help them to understand table of benefit.
  • Organize Wellness sessions for clients.

MBBS degree is mandatory
3–5 years of experience in insurance, ideally as a broker
Thorough understanding of the health insurance sector
Knowledge of the insurance and/or insurance broking industries
Understanding of the DHA's regulatory framework for the insurance sector
Strong background in customer service within healthcare/insurance
Ability to work under pressure and deliver results in a short time
Good understanding of insurance claims negotiation and settlement techniques
Ability to organize and present claim review plans effectively
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