39 Claims jobs in Saudi Arabia

Join to apply for the Claims Representative role at The Cigna Group

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Join to apply for the Claims Representative role at The Cigna Group

This role is at the heart of Cigna’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 Cigna 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.
  
  

• 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.
  
  

• Hybrid mode
• Flexibly
• International exposure
• Pleasant environment ( Cigna KSA got recently certified as “Great Place to Work” )
  
  

• Seniority level Entry level

• Employment type Full-time

• Job function Finance and Sales
• Industries Hospitals and Health Care

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Riyadh, Riyadh, Saudi Arabia 14 hours ago

Riyadh, Riyadh, Saudi Arabia 27 minutes ago

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The claims supervisor process is to deliver a quality provider statement free of technical and medical errors within the bounds of indicial policy, standard medical practice, and regulations, and take steps to improve the processes to this effect.

Key Responsibilities:

1. Inpatient Claims Operations

• Directly supervises the distribution and completion of the Inpatient claims adjudication process by the Senior Medical Officers within the KPI.
• Gets directly involved with provider claims above SR 100,000, and all claims where the adjudicators are unsure about the decision.
• Coordinates with Pre-authorization, Provider Relations, HAD, and Clinical governance for issues identified at Impotent claims, and requires corrective actions.
• Ensures smooth day-to-day Outpatient claims operations with the help of the Unit Sections Heads, who are directly involved with the team of Medical Officers.

• Works closely with the Unit Sections Heads to maintain claims production considering the projected number of claims influx, available resources, and a minimum number of average times where needed.
• Coordinates with the department manager, other departments, and with the team to implement project enhancements and policy changes in relation to business decisions.

• Maintains separate Claims Adjudication Guidelines documents for Inpatient and Outpatient workflows that align with the company's policy, business objectives, and CCHI regulations. The document will be updated at least annually for changes, and will serve as a reference guide for the claims adjudicators.
• Communicates with other medical departments to ensure clarity for the adjudicators on the guidelines where needed.

• Ensures an effective fraud and abuse identification and escalation mechanism, for the inpatient claims directly with the Senior Medical Officers, and for the Outpatient in liaison with the Medical Unit Section.

• Identifies and discusses with the department manager system/workflow opportunities for process improvement and efficiency, and leads projects in the medical team to this effect.
• Explains and clarifies statement rejection areas to aid the settlement process for the provider relations, where needed.

• Maintains internal monthly quality checks, with the help of a "quality squad" from within the team, for all adjudicators, and maintains an average of at least 95%, and provides a detailed monthly report of the team's quality to the department manager.
• Coordinates with the quality squad and Unit Sections Head for a monthly bulletin for the team with the detailed quality report, and important scenarios related to problem areas identified on the quality checks.
• Recruits good quality candidates, and assures good training, evaluation, and feedback during the probation period. Maintains a set of training material, and ensures that new joiners integrate well into the team.

Qualifications and Skills :

• Bachelors degree in Medicine (M.B;B.S./M.D or equivalent) from an accredited institution.
• Clinical Experience.
• Medical Insurance Experience in a middle management position.
• 5-10 Years Experience.

What We Offer :

• Hybrid mode
• Flexible
• International exposure
• Pleasant environment (Cigna KSA recently certified as “Great Place to Work”)

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna 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.

The Position:

We are looking for a detail-oriented claims processor to join our insurance team. You will be responsible for preparing claim forms, verifying information, and corresponding with agents and beneficiaries. You will also handle client inquiries, review policies, determine coverage, calculate claim amounts, and process payments.

To be successful as a claim’s processor, you should have excellent organizational and interpersonal skills. You should also be able to work under pressure and perform a range of clerical functions with great attention to detail.

Main Duties / Responsibilities

• A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company.
• Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information.
• In addition, a processor must keep meticulous records of claims and follow up on lapsed cases.
• Medical claims processors are expected to have an extensive knowledge of medical terminology, as well as experience using a computer.
• Recording and maintaining insurance policy and claims information in a database system.
• Determining policy coverage and calculating claim amounts.
• Processing claims payments.
• Answering queries related to Policy coverage criteria and guidelines.
• Complying with federal, state, and company regulations and policies.
• Since medical claims processors must approve or deny payment to doctors, it is vital that they know how to correctly read and assess medical documents.
• Good communication skills are necessary to converse with doctors' offices or insurance companies if there is a problem with the claim.
• Performing other clerical tasks, as required.
  

Requirements:

• Medical Qualification Background will be an added advantage.
• At least 2 years of experience as a claim’s processor or in a related role.
• Knowledge of Medical Terminologies, CPT codes and ICD-9 codes.
• Working knowledge of the insurance industry and relevant federal and state regulations.
• Computer literate and proficient in MS Office.
• Excellent critical thinking and decision-making skills.
• Good administrative and organizational skills.
• Strong customer service skills.
• Ability to work under pressure.
• High attention to details

About The Cigna Group

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.

The job profile for this position is Claims Senior Representative, which is a Band 2 Professional Career Track Role.

Excited to grow your career?

We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!

Our people make all the difference in our success.

The Position:

We are looking for a detail-oriented claims processor to join our insurance team. You will be responsible for preparing claim forms, verifying information, and corresponding with agents and beneficiaries. You will also handle client inquiries, review policies, determine coverage, calculate claim amounts, and process payments.

To be successful as a claim’s processor, you should have excellent organizational and interpersonal skills. You should also be able to work under pressure and perform a range of clerical functions with great attention to detail.

Main Duties / Responsibilities

• A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company.
• Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information.
• In addition, a processor must keep meticulous records of claims and follow up on lapsed cases.
• Medical claims processors are expected to have an extensive knowledge of medical terminology, as well as experience using a computer.
• Recording and maintaining insurance policy and claims information in a database system.
• Determining policy coverage and calculating claim amounts.
• Processing claims payments.
• Answering queries related to Policy coverage criteria and guidelines.
• Complying with federal, state, and company regulations and policies.
• Since medical claims processors must approve or deny payment to doctors, it is vital that they know how to correctly read and assess medical documents.
• Good communication skills are necessary to converse with doctors' offices or insurance companies if there is a problem with the claim.
• Performing other clerical tasks, as required.
  

Requirements:

• Medical Qualification Background will be an added advantage.
• At least 2 years of experience as a claim’s processor or in a related role.
• Knowledge of Medical Terminologies, CPT codes and ICD-9 codes.
• Working knowledge of the insurance industry and relevant federal and state regulations.
• Computer literate and proficient in MS Office.
• Excellent critical thinking and decision-making skills.
• Good administrative and organizational skills.
• Strong customer service skills.
• Ability to work under pressure.
• High attention to details

Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link .

Bachelor of Technology/Engineering(Civil), Bachelor of Laws (LLB)(Law)

Nationality

Any Arab National, Any European National

Male

Vacancy

1 Vacancy

Job Description

To oversee the preparation, submission, and negotiation of claims related to delays, variations, disruptions, and damages in construction projects. The role ensures the protection of the company’s contractual and financial interests and supports dispute resolution when necessary.

Desired Candidate Profile

• Claims Preparation and Review:
  Prepare and evaluate time and cost claims in accordance with contract terms (e.g., FIDIC, government contracts).
  Analyze the root causes of claims and ensure supporting documents and evidence are compiled.
  Draft claims in a professional and persuasive manner to maximize recovery.
• Dispute Management:
  Coordinate with the legal department in case of escalated disputes or arbitration.
  Represent the company in meetings or negotiations with clients or subcontractors.
• Cross-Department Coordination:
  Collaborate with project managers, planners, and site engineers to gather and verify data.
  Review site diaries, progress reports, schedules, and correspondence for claim substantiation.
• Contractual Analysis:
  Study and interpret key contract clauses and commercial conditions to identify risks and opportunities.
  Provide contract advice and risk assessments before project execution.
• Reporting:
  Prepare periodic reports on claim status, outstanding issues, and financial exposure.
  Advise management on strategic directions to resolve or avoid claims.
• Team Leadership:
  Supervise and guide claims engineers or analysts within the department.
  Conduct training to enhance internal claim management capabilities.
• Continuous Improvement:
  Stay updated on legal and contractual developments affecting construction claims.
  Recommend improvements to internal procedures and documentation practices.

• Bachelor’s degree in Civil Engineering, Construction Management, Law, or a related field.
• Minimum 7 years of experience in claim management within the construction industry.
• Strong knowledge of FIDIC contracts and Saudi government contracting standards.
• Proficient in English and Arabic (verbal and written).
• Solid negotiation and contractual analysis skills.

• Excellent writing and documentation skills.
• Strong analytical and problem-solving capabilities.
• High attention to detail and accuracy.
• Ability to manage pressure and meet strict deadlines.
• Effective leadership and communication skills.

Employment Type

Full Time

Company Industry

• Construction
• Civil Engineering

Department / Functional Area

• Projects

Keywords

• Contracts And Claims / Legal Affairs / Project Management

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• Dammam/Khobar/Eastern Province - Saudi Arabia

The role holder is responsible for guiding the effective and accurate assessment, administration and fair settlement of valid claims submitted by customers in line with the established claims and recovery guidelines. This role will also be responsible for the provision of requisite support to the Head, Claims and Recovery in all the recovery operations for all claims paid in line with defined recovery management procedures.

Claims

1. Complies with the guidelines and leads the collection of relevant information for investigation of claims submitted.
2. Participates and guides the investigation of submitted claims to analyse the eligibility and verification of submitted claims based on the defined policy terms.
3. Coordinates with key stakeholders from Underwriting to solicit any additional information required for analysis of claims submitted.
4. Participates in the investigation of the claims submitted by the policyholder and examines reasons for non-payment, part payment or delay in payment by the buyer in line with established guidelines for recovery or for writing-off the claim.
5. Attempts to settle the claim in an amicable manner with the involved stakeholders to ensure safeguarding of the Corporation’s interest and minimize the loss for the Corporation and policyholder.
6. Ensures all claims involving legal procedures are handed over to the Legal Department and supports the Lawyers by providing all relevant information.
7. Ensures claims notification and settlement in compliance with the policy terms and conditions, regulatory requirements and organizational guidelines governing the claims procedure.
8. Ensures all valid claims are settled fairly and documents the case for future reference and to provide inputs on improvement of product.

Recovery

1. Participates in the recovery process and liaises with buyers as and when required for recovery of payment, in line with established guidelines for the recovery process, and provides relevant information to the Legal Department team as and when required for recovery of payment.
2. Examines the method for recovery of claims i.e. through mutual agreement, through recovery agents or through Legal procedure while ensuring compliance with the organization procedures.
3. Works in close coordination with relevant stakeholders from Legal Department for soliciting legal inputs in the recovery process.
4. Forwards all recovery cases requiring Legal intervention to the Legal Department to assess the best possible low-cost recovery approach to maximize the recovery for ICIEC.
5. Ensures adherence to low-cost recovery approaches to maximize the recovery for ICIEC.
6. Maintains good relations with recovery debt collection agencies, lawyers, and other partners to aid in low-cost recovery of claims.

Departmental Responsibilities

1. Participates in the development and implementation of the Legal Affairs Department plans with respect to Claims and Recoveries, in line with the corporate objectives.
2. Manages the implementation of Legal Affairs mandates, providing leadership and facilitating work processes in order to achieve high performance standards.
3. Provides inputs in establishing strategic objectives and formulating work program of the department.
4. Ensures compliance with organizational policies, procedures and quality standards in the Legal Affairs Mandates.
5. Conducts the exercise to measure financial impact of claims and recommend appropriate actions to avoid, retain or transfer the risk.
6. Projects and calculates expected losses and makes recommendations to the Management for setting loss reserves.
7. Communicates with clients, obligors, banks and all other interested parties in claim processing.
8. Provides support in the development of ICIEC policies, guidelines, systems, procedures and tools related to claims and recoveries.
9. Proposes and designs appropriate amendments to ICIEC’s instruments including rules, policies, guidelines and regulations etc with respect to claims and recoveries.
10. Monitors new developments, including the enactment of new legislations and court decisions and evaluate their impact upon claims and recoveries in the Corporation.
11. Participates in various high-level policy-related committees established by the management of the Corporation.

Legal Documents Processing

1. Provides technical guidance to legal counsels with respect to the negotiation, review, drafting, clearance, amendment of policies and all legal documents and formal arrangements pertaining to the claims and recoveries activities of the Corporation, including among others: MoUs and cooperation agreements; non-disclosure agreements; agreements related to hiring of debt collection agencies, law firms, actuaries, consultants, surveyors, and other claim and recovery experts; and retainer documents.
2. Provides technical guidance on claims and recovery to legal counsels with respect to advising and assisting client departments in the structuring of projects, finance and investment transactions and undertake review of concept notes, appraisal reports, board documents etc.
3. Provides technical guidance on claims and recovery to legal counsels regarding interpretation and application of the Corporation’s instruments (Articles of Agreement, rules and regulations, policies, guidelines, resolutions, instructions etc.) and other contractual documents (financing agreements, procurement contracts etc.).
4. Prepares technical opinions as may be requested by the management of the department and the Corporation.
5. Assists the Manager, LAD in coordination and quality control of technical services.
6. Leads technical negotiations with external counterparts.
7. Leads the provision of technical support to Member States in connection with matters pertaining to claims and recovery objectives of the Corporation.
8. Leads the provision of technical assistance to Member Countries in connection with matters pertaining to the purpose, functions and activities of the Corporation in relation to claims and recoveries.

Reporting

1. Reviews recovery report and identifies trends from recovery metrics through various MIS and analytics, and defines action plans to minimize delinquencies and maintain health of portfolio.
2. Reviews and presents monthly management reports on claims, operating costs, claim exposures, loss ratio, etc.

People Management Responsibilities

1. Defines goals and key performance indicators for each member of the team and ensures effective application of the Corporation Performance and Development Review process.
2. Ensures high level of employee engagement and capability development by providing ongoing feedback and coaching team members.

Field of Study

Insurance/Economics/Finance/Law/Business administration (Legal background preferred)

Academic Qualifications and Relevant Experience

1. High School Diploma
2. Bachelor’s Degree
3. Master’s Degree
4. Doctorate

Experience

1. 8 Years
2. 6 Years
3. 4 Years

Nature of Experience

3-5 Years Prior experience in managing claims and recovery operations or risk underwriting, preferably in Export Credit Insurance/Banking Industry.

Professional Certifications (as applicable)

N/A

Business Language Skills

Good command of written and spoken English essential, additional languages such as Arabic, French is an added advantage.

Required Level of Interaction

Influence - Adapts style and uses persuasion in delivering messages. Issues may be complex or audience perspectives may be divergent or information may be non-routine in nature.

Key Internal Interaction

1. For coordinating with relevant Underwriters involved to solicit relevant information about the transaction and parties involved.
2. Provide inputs to underwriters on review of potential or existing insured claim experience.
3. Insurance Operations Legal for coordinating all matters related to legal procedures involved in cases of claim settlement and recovery process as and when required.
4. Country Managers for coordinating actions with policyholders.
5. Specialist, Policy Administration for coordinating actions with policyholders.
6. Policyholders for collating relevant information about the claim filed and soliciting requisite information for verification of claim.
7. Buyers for coordinating on all matters pertaining to recovery operations, identifying reasons for non-payment and identifying innovative for recovery.
8. Liaise with DCAs to increase the rate of recoveries.

Location

Travel Needed: Yes

Specific Working Conditions: N/A

If you meet the criteria and you are enthusiastic about the role, we would welcome your application. To complete the application you would need the following document(s):