Medical Claims Officer Job Description

Job Title: Medical Claims Officer

Job Overview: As a Medical Claims Officer, you will be responsible for efficiently handling and processing healthcare claims, ensuring accuracy, compliance, and timely resolution. Collaborate with healthcare providers, insurance companies, and internal teams to streamline claims procedures and contribute to the overall efficiency of the medical claims department.

Key Responsibilities:

1. Claims Processing:

   • Evaluate and process medical claims in adherence to established protocols and regulatory standards.
   • Verify accuracy of submitted claims, ensuring all required documentation is complete.
   • Investigate and resolve discrepancies or issues to facilitate prompt claim settlement.

2. Documentation and Record-Keeping:

   • Maintain comprehensive and organized records of all processed claims.
   • Ensure compliance with data protection and confidentiality guidelines in handling medical information.

3. Communication and Collaboration:

   • Liaise with healthcare providers, insurance companies, and internal stakeholders to gather necessary information.
   • Communicate effectively with claimants, addressing inquiries and providing updates on claim status.

4. Quality Assurance:

   • Conduct regular audits to ensure adherence to quality standards in claims processing.
   • Identify areas for improvement and recommend enhancements to streamline processes.

Qualifications:

• Bachelor’s degree in a relevant field.
• Proven experience in medical claims processing or a related role.
• Familiarity with healthcare regulations and insurance procedures.
• Strong attention to detail and analytical skills.
• Excellent communication and interpersonal abilities.

Skills:

• Proficient in using medical claims processing software.
• Knowledgeable about healthcare coding and terminology.
• Strong organizational and time-management skills.
• Ability to work collaboratively in a fast-paced environment.

Salary:

• Offer competitive salaries based on industry standards in the UAE.
• Consider additional benefits such as health insurance and professional development opportunities.