Our healthcare organization located in Riyadh, KSA, is currently seeking an experienced Claims Officer to join our team. In this role, you will be responsible for processing insurance claims and managing the claim procedure. You will utilize your knowledge of insurance policies and regulations to manage, evaluate, and resolve claims in a timely and efficient manner.
- Review insurance applications for compliance and adherence.
- Process new insurance claims notifications, organizing and collecting information and documentation for processing.
- Collect accurate information and documents to proceed with a claim.
- Analyze a claim made by a client and make recommendations for further investigation if necessary.
- Contact healthcare providers and witnesses during the course of investigations when necessary.
- Assess the validity of the claim and negotiate a fair settlement.
- Maintain records of claims and report on adjustments to management.
- Ensure all decisions are within compliance and company guidelines.
- Work with attorneys, medical providers, and other insurance representatives to resolve complex or contentious claims.
The ideal candidate will have a bachelor’s degree or diploma in a related field and at least two years of experience in claims processing. Knowledge of the healthcare sector and medical terminology is vital. Strong problem-solving and communication skills are essential for this role, as well as proficiency in Microsoft Office Word and Excel. The candidate must be fluent in Arabic and English.
Education & Experience:
- Bachelor’s Degree/ Diploma in a related field
- Experience of a minimum of 2 years in the same field.
- Have knowledge in claims processing.
- Microsoft Office Word & Excel proficiency.
- Problem-Solving Skills.
- Strong Communication Skills.
- Fluent in Arabic & English.