Senior Officer E-Claims
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Key skills for this role
About the Role
Transguard Workforce Solutions is recruiting a Senior Officer E-Claims for a client in Abu Dhabi. The role involves reviewing medical claims, ensuring accurate processing, and handling walk-in customers.
Key Skills for This Role
Responsibilities
- Reviewing claims for medical necessity, coding accuracy (ICD, CPT, CDT), and compliance with pre authorization and tariff agreements.
- Approving or rejecting claims within delegated authority, with proper documentation and denial codes.
- Escalating suspicious or invalid claims to supervisors.
- Ensuring adherence to SLAs, audit standards, and continuous process improvement.
- Generating reports and contributing to policy updates and cost containment initiatives.
Requirements
- Degree in Medicine, Dentistry, Pharmacy, Nursing, or Paramedics
- CPC/AHIMA certification preferred
- 3 5 years of relevant experience in the UAE required
- Proficient in English and medical coding standards
Full Job Posting
Job Purpose
- The job holder is responsible for receiving and reviewing medical claims as assigned by the supervisor, ensuring timely and accurate processing in line with insurance policies, company standards, and regulatory guidelines.
Job Description
- Reviewing claims for medical necessity, coding accuracy (ICD, CPT, CDT), and compliance with pre authorization and tariff agreements.
- Approving or rejecting claims within delegated authority, with proper documentation and denial codes.
- Escalating suspicious or invalid claims to supervisors.
- Ensuring adherence to SLAs, audit standards, and continuous process improvement.
- Generating reports and contributing to policy updates and cost containment initiatives.
Job Requirements
- Degree in Medicine, Dentistry, Pharmacy, Nursing, or Paramedics
- CPC/AHIMA certification preferred
- 3 5 years of relevant experience in the UAE required.
- Proficient in English and medical coding standards
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