Claims Representative - Healthcare

Job description

This role is at the heart of the employer’s claims processing operation in the Middle East. Claims are received from both members and providers, and the position holder will be required to organize and track workflow daily to facilitate the consistent attainment of turnaround times and other critical success factors for Claims. The position holder will also be expected to respond to queries regarding claims and coming from multiple in-house and external sources; thereby freeing the the employer Claims Team to focus exclusively upon attaining daily targets. The role will be required to be organized and efficient and accurate with strong interpersonal skills, and preferably an appreciation of medical terms. Responsibilities • Take receipt of submitted claim batches from providers, and individual claims direct from members. • Log and file claims received for tracking and planning and processing purposes. • Scanning and imaging of hard-copy claims received. • Operations planning; compiling processing schedules for the Claims Team. • Assemble processing batches and assign to team members. • Accepting finalized claims; updating status in systems and trackers as required. • Reach out to providers and members; source additional information as needed to finalize claims. • Resolve inbound queries from providers and members; maximize first time contact resolution. • Regular claims status reporting, as specified. What We Offer: • Hybrid mode • Flexibly • International exposure • Pleasant environment ( the employer KSA got recently certified as “Great Place to Work ” ) Working hours: As per KSA Labor Work About The the employer Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The the employer Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions the employer Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.

Requirements

• 1 years’ experience performing a similar role
• combining administration and stakeholder contact.
• Experience of working for an international company, preferred but not essential.
• Previous claims or insurance experience preferred but not essential.
• Broad awareness of medical terminology, advantageous.
• Excellent organizational skills, capable of following and contributing to agreed procedure.
• Strong administration awareness and experience, essential.
• Strong skills in Microsoft Office applications, essential.
• First class written and verbal communication skills, essential.
• Ability to communicate across a diverse population, essential.
• Capable of working independently, or as part of a team.
• Good time management: ability to work to tight deadlines.
• Flexible and adaptable approach, sometimes working in a fast-paced environment.
• Passion for achieving agreed objectives.

Skills