Tpa Medical Insurance jobs

Positions / Role: Medical Claims Administrator

Criteria: Prior medical claims in the insurance sector is preferred.

Qualification: Qualified Registered Nurse, Pharmacist, or other relevant healthcare professional. Good communication and interpersonal skills

Key Requirements

• Receive, review, and process medical insurance claims submitted by policyholders or healthcare providers.
• Adjudicate claims based on policy terms, coverage limits, and medical necessity criteria.
• Verify the accuracy and completeness of claim forms, medical records, and supporting documentation.
• Investigate questionable claims by contacting healthcare providers, requesting additional information or documentation, and analysing medical records.
• Make decisions on claim approvals, denials, or requests for additional information based on investigation findings and policy guidelines.
• Ensure timely and accurate processing of approved claims for payment, including coordinating with finance departments and third-party administrators.
• Communicate with policyholders, healthcare providers, and internal stakeholders regarding claim status, decisions, and any required actions.
• Maintain detailed records of claims, correspondence, and investigation outcomes in accordance with regulatory requirements and company policies.
• Ensure compliance with healthcare regulations, coding standards (e.g., ICD-10, CPT), and company policies throughout the claims process.

Salary: AED 6k + company benefits.

Note: The selected candidate will be engaged on an outsourced contract with our Talent partners

Pay: AED5,500.00 - AED6,000.00 per month

Work Location: In person