Senior Officer

5 days ago

Muscat, Muscat, Oman métier - Strategic HR Solutions Full time 90,000 - 120,000 per year

Job Purpose:

We are seeking an experienced Senior Officer – Direct Billing to join our medical insurance team. The role is responsible for managing and processing direct billing claims, ensuring compliance with policy terms, medical necessity, and regulatory requirements. The ideal candidate will have strong technical knowledge in the field of medical insurance, claims adjudication, and medical coding, while contributing to efficient claims settlement and enhancing providers satisfaction.

Key Responsibilities:

  • Process and review direct billing claims from the network providers for accuracy, medical necessity, and policy compliance.
  • Validate coding (ICD, CPT, HCPCS) and provider submissions.
  • Liaise with providers to resolve discrepancies and gather required information.
  • Identify claim irregularities, fraud, or overutilization and escalate as needed.
  • Ensure compliance with internal policies, regulations, and benefits.
  • Support audits, analyze billing trends, and prepare reports.
  • Coordinate with Finance and teams to ensure timely settlements within TAT.
  • ·Mentor junior staff and contribute to process improvements.

Educational Qualifications:

  • Bachelor's degree in Allopathic medicine, health science, Pharmacy, Physiotherapy, Nursing, Dentistry, or a related medical/paramedical field.

Experience:

  • Minimum
    3–5 years
    of experience in medical claims processing of direct billing provider claims.

Key Skills:

  • Strong knowledge of medical treatments, billing, and terminology.
  • Skilled in reviewing claims and validating coding accuracy.
  • Clear communication and negotiation with providers and stakeholders.
  • High attention to detail in claims adjudication.
  • Ability to detect trends, irregularities, and fraud.
  • Leadership skills to mentor and guide junior staff.

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