7 Claims Adjusters jobs in Saudi Arabia

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Manage the Claims process and ensure it is communicated, followed up and settled in an efficient and timely manner as per the insurance guidelines.

• Claims Process: Register claims with relevant stakeholders, validate the insurance against the set policies and determine the claim size. Track claims from submittal to settlement. Conduct provider negotiations for insurance claims.
• Manage and handle all insurance claims such as P&I, H&M, GC, Crew, Legal, etc. Review and study contracts and reports to make effective claims management decisions. Liaise with P&I Clubs, Lawyers, agents network, Surveyors and Underwriters. Act as a technical expert in the insurance claim area.
• Relationship Management: Build and maintain strong relations with legal entities P&I Clubs, H&M Underwriters, Loss Adjuster and Brokers to ensure seamless business support.
• Reconcile claim’s summary for the Manager’s review in order to validate correct measures.
• Concepts & Policies: Define insurance claims guidelines and procedures to mitigate risk exposure and cost of insurance claims. Adopt and apply new professional strategies and policies within the area of responsibility in accordance with management directions.
• Identify and mitigate risk exposure for all insurance matters related to P&I and H&M Policies.

• Bachelor degree in Insurance Claims, Risk Management or equivalent.
• Minimum 4 years of relevant experience in Claims handling and Loss prevention.

• Qualification from The Chartered Insurance Institute (CII) is preferred.

• Associate

• Full-time

• Finance and General Business

• Transportation, Logistics, Supply Chain and Storage, Maritime Transportation, and Insurance

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Responsibilities:

• Reviewing claims in preparation for their submission to insurance companies
• Collecting, organizing, and storing claims files using computers and filing systems.
• Follow-up and Processing of claims complaints.
• Ensure to comply with the Insurance Company requirements.
• Complete logs, reports, forms and records to properly document medical claims.
• Filing all approved claims.
• Making and reviewing all claims bills for medical and non-medical services.
• Coordinate with the insurance specialist for speedy processing of patients’ documents.
• Identify and escalate customer issues to immediate Supervisor.
• Contribute to ensure all requirements documents are submitted for reimbursement claims.
• Inform the team for any new regulations of the insurance field.
• Coordinate with insurance specialist and billing team for any additional document support.
• Protects operations by keeping claims information confidential.
• Performs other related duties as assigned by management.

Job Purpose:

Manage the Claims process and ensure it is communicated, followed up and settled in an efficient and timely manner as per the insurance guidelines.

Key Accountabilities:

Claims Process:

Register claims with relevant stakeholders, validate the insurance against the set policies and determine the claim size. Track claims from submittal to settlement. Conduct provider negotiations for insurance claims.

Manage and handle all insurance claims such as P&I, HH&M, GC, Crew, Legal…etc. Review and study contracts and reports to make effective claims management decisions. Liaise with P&I Clubs, Lawyers, agents network, Surveyors and Underwriters. Act as a technical expert in the insurance claim area.

Relationship Management:

Build and maintain strong relations with legal entities P&I Clubs, H&M Underwriters, Loss Adjuster and Brokers to ensure seamless business support.

Reconciliation:

Reconcile claim's summary for the Manager's review in order to validate correct measures.

Concepts & Policies:

Define insurance claims guidelines and procedures to mitigate risk exposure and cost of insurance claims. Adopt and apply new professional strategies and policies within the area of responsibility in accordance with management directions.

Risk Management:

Identify and mitigate risk exposure for all insurance matters and related to P&I and H&M Policies.

Qualifications and Experience:

Bachelor degree in Insurance Claims, Risk Management or equivalent.

Minimum 4 years of relevant experience in Claims handling and Loss prevention.

Professional Certificates and Licenses:

ACII or qualification from The Chartered Insurance Institute (CII)

or equivalent is preferred.

This role exists to ensure operational excellence in the end-to-end cash collection and claims management cycle. Corresponding with customers to close open invoices, settle claims, resolve disputes, and reconcile balances. Coordinating with colleagues in logistics and sales for open actions and to highlight risks or manage bad debts.

Unilever is an organisation committed to equity, inclusion and diversity to drive our business results and create a better future, every day, for our diverse employees, global consumers, partners, and communities. We believe a diverse workforce allows us to match our growth ambitions and drive inclusion across the business. At Unilever we are interested in every individual bringing their 'Whole Self' to work and this includes you Thus if you require any support or access requirements, we encourage you to advise us at the time of your application so that we can support you through your recruitment journey.

Job Title: Claims / Approvals Officer

Department: Medical Claims / Insurance Approvals

Location: (Riyadh, Saudi Arabia)

Reports to: Claims Manager / Approvals Supervisor

Job Purpose:

To review, process, and validate medical claims and approval requests in accordance with company policies and insurance guidelines, ensuring accuracy, compliance, and timely decision-making to support operational efficiency and customer satisfaction.

Key Responsibilities:

• Review and assess medical claims and pre-approval requests submitted by healthcare providers.
• Ensure all claims are compliant with insurance policies, coverage limits, and contractual agreements.
• Coordinate with medical teams and insurance companies to verify medical necessity and eligibility.
• Approve or reject claims based on established criteria and documentation.
• Maintain accurate records of claims decisions and approvals in the system.
• Respond to inquiries from internal departments, providers, and insurers regarding claim status.
• Identify and escalate suspicious or fraudulent claims for further investigation.
• Support continuous improvement of claims processing procedures.
• Ensure timely processing to meet service level agreements (SLAs).

Qualifications:

• Bachelor's degree in healthcare administration, Insurance, Business, or a related field.
• Knowledge of medical terminology, insurance policies, and healthcare procedures.
• Language Requirement: Fluency in both Arabic and English (spoken and written) is mandatory.

Experience:

• 2–4 years of experience in medical claims processing, insurance approvals, or healthcare administration.
• Familiarity with claims management systems and electronic health records (EHR).
• Experience working with insurance companies or third-party administrators (TPAs).
• Understanding of regulatory and compliance standards in healthcare claims.

Soft Skills:

• Attention to Detail: Ensures accuracy in claim reviews and documentation.
• Analytical Thinking: Evaluates complex medical and insurance data to make informed decisions.
• Communication Skills: Effectively communicates with providers, insurers, and internal teams.
• Time Management: Handles multiple claims and approvals within tight deadlines.
• Integrity and Confidentiality: Maintains discretion and ethical standards in handling sensitive information.
• Problem-Solving: Resolves claim discrepancies and approval issues efficiently.
• Customer Service Orientation: Responds professionally to inquiries and ensures stakeholder satisfaction.
• Adaptability: Works well in a fast-paced and evolving regulatory environment.

Job Types: Full-time, Contract

Contract length: 12 months

Pay: ﷼5, ﷼7,500.00 per month

Duties and Responsibilities

Claims Processing Oversight

• Support the Manager in supervising daily claims / batch intake, validation, adjudication, and settlement activities.
• Ensure compliance with Nphies e-claims standards , coding standards, MDS and timeline specified per regulations.
• Monitor turnaround times (TAT) to meet internal and external service-level agreements (SLAs).

Quality Assurance & Compliance

• Assist in implementing internal controls to ensure claims accuracy and prevent fraud, waste, and abuse.
• Coordinate with internal audit and compliance teams to maintain adherence to CCHI guidelines and regulatory directives.
• Contribute to training programs for staff and providers on correct claims submission and reconciliation processes.

Discrepancy Resolution

• Oversee investigation of claim discrepancies, rejections, and denials, and ensure timely resolution.
• Support communication with healthcare providers, external and internal teams / stakeholders to address recurring issues.
• Escalate unresolved or high-impact discrepancies to the Senior Claims Manager with recommended solutions.

Stakeholder Management

• Act as deputy contact point for healthcare providers, external and internal stakeholders and claims staff.
• Provide guidance to healthcare providers on claims processing requirements and Nphies compliance.
• Participate in regular meetings with hospitals, clinics, and pharmacies to strengthen provider relations.

Reporting & Continuous Improvement

• Prepare operational dashboards and performance reports for management review.
• Support process re-engineering projects to reduce rejections and enhance claims accuracy.

People Management & Performance

This role is critical for the day-to-day leadership and performance development of the claims processing team, which is vital for a Tier 1 insurance company's operational excellence.

1. Team Oversight & Support: Supports the Manager in supervising daily claims intake, validation, adjudication, and settlement activities.
2. Training & Development: Contribute to training programs for staff and providers on correct claims submission and reconciliation processes.
3. Performance Management (Tactical): Oversee investigation of claim discrepancies, rejections, and denials, and ensure timely resolution. Identify trends in denials and contribute to corrective action plans.
4. Risk & Compliance Culture: Acts with due diligence to safeguard company interests. Maintain highest level of confidentiality.

KPI Monitoring, Reporting, and Continuous Improvement

This area transforms raw claims data into actionable insights for management, a non-negotiable for a large insurer focused on efficiency and cost control.

1. KPI Monitoring: Monitor turnaround times (TAT) to meet service-level agreements (SLAs). Support the oversight. of the end-to-end claims processing management cycle. TAT/SLA Compliance: Time taken from claim receipt to final settlement. First-Pass Ratio (FPR): Percentage of claims processed without manual intervention or rejection.
2. Reporting & Analysis: operational dashboards and performance reports for management review. Identify trends in denials.
3. Continuous Improvement: process re-engineering projects to reduce rejections and enhance claims accuracy.

Education:

Bachelor’s degree in Medicine / Pharmacy, Healthcare Administration, Business Administration or Health Informatics.

Experience:

• Hands-on experience in Medical Claims Processing domain (3–5 years minimum)
• Healthcare Insurance & Regulatory Compliance (5+ years preferred)
• Understanding of Medical Claims Processing

Personal Attributes / Skills:

1. Integrity & Ethical Mindset – Strong moral principles to handle sensitive financial and healthcare data responsibly.
2. Attention to Detail – Ability to spot anomalies, inconsistencies, and patterns in data.
3. Analytical Thinking – Logical approach to problem-solving and decision-making.
4. Critical Thinking – Evaluating evidence to determine fraud risks and compliance gaps.
5. Persistence & Patience – Fraud investigations and reconciliations can be complex and time-consuming.
6. Communication Skills – Clear reporting of findings to internal teams, auditors, and regulators.
7. Confidentiality & Discretion – Handling sensitive patient and financial information with care.
8. Adaptability – Keeping up with evolving fraud schemes and regulatory changes.

Others:

• Fluency in Arabic language, working knowledge of the English language is an advantage.
• Proficiency in using Microsoft Office applications and database management.
• Ability to work independently and as part of a team to achieve network management goals.