Claims Officer

HealthCare
Dubai
February 26, 2025
Full Time
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Job Description

As a member of Munich Re the MedNet Group is a leading Third-Party Administrator across the MEA region.

We are currently seeking to hire a UAE National “Claims Officer” The job holder responsibilities are: Adjudicate, Process & Audit Network / Reimbursement outpatient & Inpatient claims.

Your Role:

  • · Manage daily claims administration work of review and processing of claims in line with scope of coverage and provider contracts.
  • · Audit claims data to identify any Fraud waste and abuse activities.
  • · Ensure accuracy and consistency of data.
  • · Forward approved claims once processed to PICs (Preferred Insurance Companies) for their acknowledgment or approval as per thresholds.
  • · Review and respond to claims audits of clients and internal audits.
  • · Answering provider, Insured members, and PICs queries accurately via phone calls and emails, regarding claims processing to provide clarifications where needed.
  • · Work in accordance with defined SOP’s.
  • · Work with high efficiency, minimizing errors and administration time to achieve monthly deadlines.
  • · Entering data accurately to provide accurate records to the company and PICs.
  • · Respond to external inquiries politely and professionally.

Your profile:

  • · Diploma In Nursing, Physiotherapy and Pharmaceutical Sciences.
  • · Coding certifications is an added advantage.
  • · 2-3 years of experience in claims in the insurance industry or TPA/MSO Company.
  • · Computer literate and excellent knowledge of MS office.
  • · Excellent interpersonal and communication skills.
  • · Working on split or straight shifts according to business needs.
  • · Very good command of English.
  • · Ability to communicate sensitively and effectively with internal and external stake holders having regard for the strict need for confidentiality.
  • · Advanced knowledge of Microsoft packages (Word, PowerPoint, and Excel) e-mail, electronic calendar, and the Internet.
  • · Ability to work well with all levels of internal management and staff, as well as outside clients.

Minimum Qualifications:

  • · Diploma In Nursing, Physiotherapy and Pharmaceutical Sciences.
  • · Coding certifications is an added advantage.
  • . Must be a UAE National and have a Family Book.

Minimum Experience:

· 2-3 years of experience in claims in the insurance industry or TPA/MSO Company.

*Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunities employer.

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