Medical Claims Officer

• Perform Claims review as per CPT and ICD coding guidelines in line with insurance regulators
  (DHA,DOH/HAAD,MOH)
• Oversee Compliance & Regulatory requirements & enforcement
• Portfolio Analysis Reports for Medical + Reserving Review
• Client Servicing & Update scheme performance
• System Requirements/Developments
• Analyse utilization trends and behaviors of Medical Providers
• Audit Medical Providers and TPA
• Report Fraud, Waste & Abuse
• Provider Payments and Reconciliations
• Prepare and process claim files, special approvals, accounting docs, memo's, etc.

• Bachelor's Degree in Medical related discipline.
• Insurance-related certifications and licenses as required by UAE regulations.
• Coding experience ICD 10 & CPT
• A minimum of five year’s experience in medical insurance in the UAE market preferably with a
  Medical Insurer OR TPA
• Good experience with Microsoft applications especially Advanced Excel & Analytical software.