4 Claims Adjusters jobs in Saudi Arabia

Claims Specialist

Riyadh, Riyadh Alborglaboratories

Posted 16 days ago

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Job Description

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The Claims Specialist is responsible for the accurate processing and submission of electronic and paper claims through the NPHIES platform and/or other payers' protocols, ensuring complete and appropriate reporting of services. This role guarantees timely claim submissions to secure payments and resolve accounts receivable issues.

Primary Duties and Responsibilities
  1. Prepare all services provided to insurance patients in a defined claim format for submission to NPHIES to facilitate reimbursement.
  2. Prepare invoices, collect claim forms, pre-authorization/approvals, prescriptions, radiology reports, laboratory reports, and other relevant medical documents.
  3. Prepare monthly claims for insurance and non-insurance payers according to contractual terms and billing protocols.
  4. Adhere to submission timelines and submit claims promptly to ensure quick reimbursement.
  5. Complete claim structures with all necessary medical and financial information supported by relevant reports and documents.
  6. Manage the resubmission process for error or rejected claims efficiently.
  7. Provide timely reports to relevant stakeholders.
  8. Scan and collect all hard copy forms to complete soft copy claims for non-insurance payers.
  9. Submit original complete claim forms.
  10. Print results from facility systems as needed to complete claims.
  11. Follow up with stakeholders to gather lab, radiology, and medical reports for invoice attachment.
  12. Attach documents to corresponding invoices.
  13. Conduct comprehensive reviews of completed claims.
  14. Prepare and submit claim reports and tax invoices in the required formats.
  15. Report any defects, challenges, or risks that may hinder timely task completion.

Follow line manager instructions regarding duty hours, vacations, productivity, and assigned tasks.

Requirements
  • Over 2 years of experience in medical billing and insurance claims processing.
  • Deep understanding of KSA healthcare regulations, payer guidelines, and the NPHIES platform.
  • Experience with Electronic Health Records (EHR) systems and billing software.
  • Knowledge of ICD-10 and SBS coding.
  • Excellent data entry and accuracy skills.
Minimum Educational Qualifications
  • Degree(s): PhD in Genetics or MD with a Clinical Pathology or Genetics specialty.
  • License: Classified as a Laboratory Consultant in Genetics by the Saudi Council for Health Specialties.
Key Performance Indicators
  • Achieve 100% of daily production targets.
  • Maintain rejection rates below 5% for claims processing denials.
  • Achieve over 98% error-free quality on tasks.
  • Ensure 100% adherence to payers' and Al Borg's processes and protocols.
Additional Details
  • Seniority Level: Entry level
  • Employment Type: Full-time
  • Job Function: Management
  • Industries: IT Services and IT Consulting

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Location: Riyadh, Saudi Arabia; Posted 10 hours ago.

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Senior Specialist - Claims and Recovery

Jeddah, Makkah Islamic Development Bank

Posted 16 days ago

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Job Description

IDB3447 - Senior Specialist - Claims and Recovery

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.

KEY RESPONSIBILITIES

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.
JOB REQUIREMENTS

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.

KEY INTERACTIONS

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.
WORKING CONDITIONS

Location

Travel Needed: Yes

Specific Working Conditions: N/A

About Application Process

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):

#J-18808-Ljbffr
This advertiser has chosen not to accept applicants from your region.

Senior Specialist - Claims and Recovery

Jeddah, Makkah Islamic Development Bank

Posted today

Job Viewed

Tap Again To Close

Job Description

IDB3447 - Senior Specialist - Claims and Recovery

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.

KEY RESPONSIBILITIES

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.
JOB REQUIREMENTS

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.

KEY INTERACTIONS

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.
WORKING CONDITIONS

Location

Travel Needed: Yes

Specific Working Conditions: N/A

About Application Process

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):

#J-18808-Ljbffr
This advertiser has chosen not to accept applicants from your region.

Insurance Supervisor (Medical Claims Processing &

Riyadh, Riyadh ACCUMED

Posted today

Job Viewed

Tap Again To Close

Job Description

The supervisor role is responsible for providing leadership and management of day to day operations that result in the provision of an efficient, accurate and timely claims management for OP and IP cases. To be successful in the role, needs excellent understanding of the claim and submission process with the knowledge of the payer, provider contracts. The ability to communicate these to the team and other stake holders as appropriate. vigilant monitoring of the claims and ensuring the whole claims are clean to minimize denials.

**Responsibilities**

1. Supervise all revenue cycle and central billing office staff
2. Responsible for all activities within the central billing office
3. Work with other members of Revenue Cycle Management team in cultivating and managing strong relationships both internally and externally
4. Ensure adherence to and compliance of payor, government and internal system regulatory policies
5. Audit productivity and quality of the team
6. Create, maintain, update and provide training on policies and procedures
7. Identify potential process improvements
8. Carry out supervising responsibilities in accordance with the organizations policies

**Requirements**:

- Educational Background: Any related Degree to Finance or Business Administration, Degree in Life science is preferable
- Requires an understanding of insurance billing, ICD-10/CPT codes,
- 5 years billing experience with 1 year in supervisory role
- Excellent verbal/written communication skills
- Experience with accounts receivable and understanding of the revenue cycle for payors
- Experience in integrated health care systems
- Proficient in Microsoft Office (Word, Excel, PowerPoint, etc.
This advertiser has chosen not to accept applicants from your region.
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