Job Overview
Waseel is looking for a Claims Specialist to join our team to work in In different regions in Saudi Arabia !
Key Responsibilities
Review and verify the accuracy of medical claims submitted by healthcare providers, ensuring compliance with company policies, procedures, and regulatory requirements.
- Superior math aptitude and strong analytical ability
- Assess claim eligibility based on insurance policies, coverage plans, and pre-established guidelines.
- Determine coverage limitations, exclusions, and any additional documentation requirements
- Process medical claims accurately and efficiently using designated software or systems. Input necessary data, codes, and documentation to facilitate timely payment or denial of claims
- Experience with reserving and pricing techniques if having prior health and general insurance experience
- Superior math aptitude and strong analytical ability
- Collaborate with healthcare providers, insurance companies, and policyholders to resolve claim-related inquiries, discrepancies
- Ability to work both independently and as part of a team
Requirements
- Previous experience in healthcare claims processing or medical billing is highly desirable
- Familiarity with medical terminology, coding systems (ICD), and insurance practices
- Proficiency in using computer software and databases for data entry, retrieval, and analysis
- Strong attention to detail, analytical skills, and ability to multitask in a fast-paced environment
- Excellent communication skills, both verbal and written, with the ability to interact professionally with diverse stakeholders
Job Requirements
- Bachelor's degree is required
- Advance verbal and written communication skills
- Mid-level positions require +2 years of experience
- Healthcare provider organizations (hospitals, clinics, medical practices)
- Certified Professional( IFCE )
- Certified Professional (RCM )