
Claims Executive
23 hours ago
Job Description
We are looking for a highly skilled DB Claims Executive to join our team. The successful candidate will have a strong understanding of claims processing, excellent communication skills, and a medical education degree.
Responsibilities
• Manage the claims processing workflow, coordinating the workflow within the direct billing claims department.
• Ensure the accuracy and quality of claims processing within the team, conducting regular audits and quality checks.
• Evaluate claims based on policy terms and conditions, medical necessity, and coding guidelines.
• Report potentially fraudulent or suspicious claims and collaborate with relevant departments.
• Maintain accurate and up-to-date information on contracted healthcare providers.
• Assist in the evaluation and review of claims rejections.
• Ensure proper replies to email communications in a professional and timely manner.
Requirements
• Due to regulatory requirements, only Omani nationals will be considered for this role.
• Medical education degree is required (Physician or Dental).
• Very good communication skills.
• Excellent command of English language.
Desirable
• 2-3 years of experience in Claims processing, Employee benefits/ Healthcare and / Group Life.
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