11 Claims Processing jobs in Saudi Arabia

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.

Exciting Career Opportunity – Leading Construction Company

We are seeking a highly skilled professional to join our team.

• Job Purpose
  
  We are seeking a Contracts & Claims Specialist to manage claims, variations, and negotiations across projects, ensuring compliance and protecting the company's commercial interests.

Key Responsibilities:

• Monitor contracts for deviations leading to claims or variations.
• Prepare and compile claim submissions with justifications and documentation.
• Support negotiations on contract terms, claims, and variations.
• Collaborate with project teams and legal advisors on disputes.
• Maintain a claims register and ensure audit-ready documentation.
• Prepare reports on claims, trends, and risks for management review.

Requirements:

• Bachelor's degree in Law, Quantity Surveying, Engineering, or Construction.
• Preferred: Certification in Claims Management or Construction Law.
• Strong negotiation, documentation, and dispute resolution skills.

Engineering Contracts & Claims Management Lead Specialist

Purpose of Job: Jobholders at this level are experienced professionals capable of conducting work with general directions. They are primarily concerned with developing solutions to challenges which require some analysis to understand and resolve, and addressing issues escalated from junior levels. They undertake complex operational activities including reviewing developed RFPs, assisting in analysing received bids, preparing memorandum of understanding and SLA agreements to consolidate contracts development.

• Coordinate with related stakeholders to collect technical project requirements and specifications to identify vendors needed qualifications
• Format and combine technical and financial tendering requirements to finalize tendering packages
• Provide support in RFPs development including set requirements and specifications to solicit offers for selected project
• Upload and submit developed RFPs and other tender documents to Procurement function via Secure File Sharing System SFS to proceed with bidding process
• Conduct and in-depth analysis of all bids received from vendors and outsourced service providers in response to each tender to identify the responses that best meets the requirements and is consistent with procurement standards
• Prepare regular status report on ongoing tendering and evaluation activities for tracking purposes
• Conduct first filtering based on profile fit and elementary requirements in order to optimize and facilitate the tendering process
• Receive and review technical and financial proposals and handle Requests For Information to ensure a clear understanding of project requirements
• Assess and select best bids in coordination with relevant committees and stakeholders ensuring all project’s specifications are mentioned to proceed with project planning and execution
• Prepare memorandum of understanding and SLA agreements to facilitate the cooperative work between ZATCA and external stakeholders
• Collect and communicate queries to related stakeholders securing on time and efficient resolution
• Prepare contract’s details based on bidding proposal selections, to secure all technical and financial details are mentioned
• Review and validate contract drafts ensuring compatibility between requirements and contract details to secure deal closure and contract signature
• Coordinate with Procurement function to conduct meetings with contractors to determine their capability of working with ZATCA
• Develop and regularly update database and dashboard to keep track of contracts implementation
• Follow all relevant policies, processes and standard operating procedures so that work is carried out in a controlled and consistent manner
• Help in solving escalated problems and provide needed support for junior team to ensure work is carried out in an efficient manner
• Escalate complex problems to the relevant person to ensure cases/issues are closed properly
• Perform other duties as requested
• Train junior staff on the different job activities to ensure transfer of know-how, when applicable
• Provide clear direction, prioritize tasks, assign and delegate responsibility, and monitor the workflow of subordinates/ junior staff
• Support junior staff or direct reports in order to execute their duties according to set policies and processes

Bachelor’s degree in Business Administration or equivalent is required

A minimum of 4 years of relevant experience

• Collaboration and Communication - Developing
• Legislations and Regulations - Advanced
• Professionalism - Proficient
• Engineering Knowledge and Analysis - Proficient
• Results Oriented - Proficient
• Engineering Strategic Planning - Proficient
• Customer Focus - Proficient
• PMO Management - Proficient
• Engineering Contracts Management - Advanced
• Enablement of Change and Innovation - Developing

Mid-Senior level

Contract

Engineering and Information Technology

Government Administration

MEDICAL CLAIMS ANALYST

Corporate

Unit Manager

Independent contributor role focused on specialized claims adjudication and pattern recognition. Responsible for handling trend-based claims while identifying process improvements and serving as a resource for junior staff.

5%

• Identify emerging claim patterns and propose minor process improvements

• Contribute to workflow optimization through trend analysis

95%

• Independently review specialized and trend-based medical/dental claims
• Apply clinical and policy knowledge to complex scenarios
• Identify patterns in claim data and propose process improvements
• Conduct self-audits on 10% of own work for accuracy against clinical guidelines
• Draft initial responses to provider disputes for supervisor review
• Serve as resource for Level 1 staff on common claim scenarios
• Maintain expertise in current policy and clinical guidelines

Bachelor degree in healthcare administration, business, or related field preferred

2-4 years of claims processing experience in healthcare or insurance

Arabic : Advanced

English : Advanced

• Accounts Receivable
• Billing Investigations
• Billing Statement Preparation

• Excellence
• Integrity
• Accountability
• Cybersecurity
• Person-Centered Care

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Insurance Claims Adjuster

An Insurance Claims Adjuster is responsible for investigating insurance claims to determine the cause, extent, and value of a loss or damage. The goal is to ensure fair and accurate claim settlements in line with the policy terms. Claims adjusters assess the situation, review evidence, and prepare professional reports that support decision-making.

⸻

Key Responsibilities:

• Investigate claims related to accidents, property damage, or other covered losses

• Interview claimants, witnesses, and relevant experts to gather facts

• Review insurance policies, reports, and supporting documents

• Accurately estimate repair or replacement costs

• Recommend fair and appropriate claim settlements

• Detect and report any potential fraud or inconsistencies

• Write clear, professional reports for insurance companies

⸻

Required Skills:

• Strong English language skills (written and spoken) for professional report writing

• Excellent communication and negotiation abilities

• Analytical and investigative thinking

• High attention to detail and accuracy

• Basic knowledge of insurance policies, coverage, and claims procedures

• Ability to work independently under deadlines and pressure

Claims Lead Analyst

Join to apply for the Claims Lead Analyst role at The Cigna Group .

We are looking for a detail-oriented Claims Analyst Lead to join our insurance team. You will be responsible for preparing claim forms, verifying information, corresponding with agents and beneficiaries, handling client inquiries, reviewing policies, determining coverage, calculating claim amounts, and processing payments.

• 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.
• Keep meticulous records of claims and follow up on lapsed cases.
• Have an extensive knowledge of medical terminology and experience using a computer.
• Record and maintain insurance policy and claims information in a database system.
• Determine policy coverage and calculate claim amounts.
• Process claims payments.
• Answer queries related to policy coverage criteria and guidelines.
• Comply with federal, state, and company regulations and policies.
• Read and assess medical documents to approve or deny payment to doctors.
• Communicate with doctors’ offices or insurance companies if there is a problem with the claim.
• Perform other clerical tasks as required.

• Medical qualification background will be an added advantage.
• At least 5 years of experience as a claim 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 detail.

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 job profile for this position is Claims Lead Analyst, which is a Band 3 Senior Contributor 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.

We are looking for a detail-oriented claims Analyst Lead to join our insurance team.

You will be responsible for preparing claim forms, verifying information, and corresponding with agents and beneficiaries and also handle client inquiries, review policies, determine coverage, calculate claim amounts, and process payments.

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

Context : Must have a Technical expertise with depth or breadth of knowledge within Claims, Responsible for researching and resolving escalated and complex claim issues in a timely manner. Identifies error trends and notifies the appropriate areas for correction, communicating/educating the necessary parties. Provides recommendations regarding process improvements. Communicates with service providers, attorneys, policyholders, and other involved parties. Provides guidance, coaching, and direction to more junior team members of the team. Acts independently working under limited supervision.

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.

Requirement :

• Medical Qualification Background will be an added advantage.
• At least 5 years of experience as a claim 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.

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.

Requirement :

• Medical Qualification Background will be an added advantage.
• At least 5 years of experience as a claim 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

You will be responsible for preparing claim forms, verifying information, and corresponding with agents and beneficiaries and also handle client inquiries, review policies, determine coverage, calculate claim amounts, and process payments.

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

Context : Must have a Technical expertise with depth or breadth of knowledge within Claims, Responsible for researching and resolving escalated and complex claim issues in a timely manner. Identifies error trends and notifies the appropriate areas for correction, communicating/educating the necessary parties. Provides recommendations regarding process improvements. Communicates with service providers, attorneys, policyholders, and other involved parties. Provides guidance, coaching, and direction to more junior team members of the team. Acts independently working under limited supervision.

We are looking for a detail-oriented claims Analyst Lead to join our insurance team.

You will be responsible for preparing claim forms, verifying information, and corresponding with agents and beneficiaries and also handle client inquiries, review policies, determine coverage, calculate claim amounts, and process payments.

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

Context : Must have a Technical expertise with depth or breadth of knowledge within Claims, Responsible for researching and resolving escalated and complex claim issues in a timely manner. Identifies error trends and notifies the appropriate areas for correction, communicating/educating the necessary parties. Provides recommendations regarding process improvements. Communicates with service providers, attorneys, policyholders, and other involved parties. Provides guidance, coaching, and direction to more junior team members of the team. Acts independently working under limited supervision.

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.

Requirement :

• Medical Qualification Background will be an added advantage.
• At least 5 years of experience as a claim 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

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.