Job Description

Our client is looking to hire a Medical Claims Processor to be based in Dubai, UAE.

The Medical Claims Processor will be responsible for assisting in managing functions related to the company activities, i.e., Preauthorization, Claims, Case management and additional inter departmental support, keeping the quality and cost efficiency parameters in mind.

Key Responsibilities:

Preauthorization and Claims Management:

• Review and process preauthorization and claims in line with policy terms and conditions within TAT.
• Review the current preauthorization and claims handling processes to identify bottlenecks and inefficiencies.
• Streamline preauthorization and claims processing workflows by implementing automation and standardization measures.
• Monitor and analyze key performance indicators (KPIs) such as turnaround time (TAT) and accuracy to ensure timely and error-free processing.

Develop Comprehensive User Manuals/DTPs

• Research and analyze existing user manuals and DTPs to identify gaps and areas for improvement.
• Create detailed plans for updating and enhancing user manuals and DTPs to ensure clarity and ease of understanding.
• Collaborate with relevant teams to gather feedback and iterate on the manuals/DTPs to meet user needs effectively.

Enhancing System User Experience for Modular Approach:

• Audit and maintain existing database/Medical Library usage related to preauthorization and claims processing to identify optimization opportunities.
• Develop and implement automated rules within the database system to expedite preauthorization and claims processing while ensuring compliance with regulations.

Client Training Programs:

• Assess the current client training programs to understand strengths and weaknesses.
• Develop tailored training modules focusing on product features, preauthorization’s, claims processing, and system usage.
• Implement interactive training sessions incorporating feedback mechanisms to enhance engagement and knowledge retention among clients.

Required Qualifications and Skills:

• Bachelor’s degree in Para Medical Science is essential from Allopathic Stream
• Minimum of 2-3 years’ experience in the related industry and especially from a TPA.
• CPC, CII certificate, LOMA, CCS is an added advantage, but not a necessity.
• Advanced knowledge of Microsoft office products including Outlook, Word, and Excel
• Good knowledge of health insurance industries and regulations.
• Adequate verbal and written communication skills, demonstrating the ability to convey business terminology that is meaningful and well received by all stakeholders, including customers and associates.