Clinical Adjudication Specialist Role

2 days ago


Muscat, Muscat, Oman beBee Careers Full time
Job Description
As a Clinical Adjudication Specialist, you will play a crucial role in ensuring the accuracy and efficiency of our medical claims process. Your responsibilities will include:

Main Duties:
  • Review DRG Severity of Illness (SOI) in line with CPT and ICD code revisions.
  • Conduct utilization reviews for DRG and FFS cases, including final bill review and cost containment protocols.
  • Comply with insurance regulators' guidelines and maintain knowledge of industry best practices.

Essential Qualifications:
  • Legally permitted to work in the country of operations.
  • Physically fit to perform duties.
  • Proficiency in MS Office and strong internet research skills.


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