TPA Medical Claims Officer
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Key skills for this role
Role Overview
The position is a Medical Claims Administrator within a third-party administrator context.
Key Skills for This Role
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Role
The position is a Medical Claims Administrator within a third-party administrator context.
Criteria and Qualifications
- Prior medical claims experience in the insurance sector is preferred.
- The candidate must be a qualified Registered Nurse, Pharmacist, or other relevant healthcare professional.
- Good communication and interpersonal skills are required.
Key Requirements and Duties
- Receive, review, and process medical insurance claims from policyholders or healthcare providers.
- Adjudicate claims according to policy terms, coverage limits, and medical necessity criteria.
- Verify claim forms, medical records, and supporting documentation for accuracy and completeness.
- Investigate questionable claims by contacting providers and requesting additional information.
- Analyze medical records and decide on claim approvals, denials, or requests for more information.
- Coordinate approved claim payments with finance departments and third-party administrators.
- Communicate claim status, decisions, and required actions to relevant stakeholders.
- Maintain detailed records in accordance with regulatory requirements and company policies.
- Ensure compliance with healthcare regulations, ICD-10 and CPT coding standards, and company policies.
Compensation
- The description states a salary of AED 6,000 plus company benefits.
- The pay listing states AED 5,500 to AED 6,000 per month.
Work Location
- The role is performed in person.
Engagement
The selected candidate will be engaged on an outsourced contract with the company's talent partners.
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