Medical Reimbursement Officer

2 weeks ago

Muscat, Muscat, Oman Consulture Search Full time 3,120 - 36,000 per year
ONLY FILIPINO NATIONALS NEED APPLY

Job Purpose:

We are looking for a qualified Officer to join our medical reimbursement team. The role involves reviewing and processing reimbursement claims for medical services, ensuring they are clinically justified, supported by valid documentation, and compliant with the table of benefits and health protocols. The ideal candidate will collaborate with brokers, clients, and internal teams to ensure timely, accurate, and customer-focused decisions.

Key Responsibilities:

  • Review and process medical reimbursement claims for accuracy, eligibility, and clinical validity.
  • Verify supporting documents (invoices, prescriptions, reports) to ensure compliance with policy and benefits.
  • Ensure adherence to insurance regulations, internal protocols, and medical guidelines.
  • Coordinate with brokers, clients and policyholders to clarify or obtain required documentation.
  • Identify and escalate fraudulent, abnormal, or non-compliant cases.
  • Provide recommendations for claim approvals or rejections based on evidence.
  • Work with Finance and Claims teams to ensure timely settlement of approved claims.
  • Handle claim disputes fairly and in line with company policies.

Educational Qualifications:

Bachelors degree in Allopathic medicine, health science, Pharmacy, Physiotherapy, Nursing, Dentistry, or a related medical/paramedical field.

Experience:

Minimum 2 years of relevant experience in the medical field, insurance claims, or reimbursement function.

Key Skills:

  • Solid knowledge of medical treatments and terminology.
  • Strong ability to review reimbursement documents and medical records.
  • Clear communication skills for dealing with brokers, clients and policyholders.
  • High accuracy and attention to detail in claim evaluation.
  • Sound judgment in handling complex cases.
  • Ability to analyze trends and detect claim irregularities.

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