- Job Title Medical Claims Officer (Insurance)
- Type - Outsourced
- Contract Duration- 6 months Extendable (Immediate Joiners)
- Work Location Dubai Outsource City
- Salary AED 5000
- Working days & timings 6 days work
Mandatory details/Skills Experience working with Insurance companies (Not hospitals), Experience working with TPA, Good knowledge on Policy Management Systems, Arabic Speakers Preferred, Immediate Joiners only
Job Summary
The Medical Claims Officer is responsible for accurate and timely adjudication of medical insurance claims in compliance with payer policies, UAE healthcare regulations, and international coding standards. The role requires strong clinical knowledge, analytical skills, and experience in utilization review, fraud detection, and provider communication to ensure claim accuracy and cost control.
Key Responsibilities
- Review, process, and adjudicate medical insurance claims in line with ICD-10, CPT, DRG, and payer policies.
- Conduct utilization review and assess medical necessity using evidence-based medicine.
- Validate member eligibility, coverage limits, benefits, and prior authorizations.
- Manage claim denials, reconsiderations, and documentation discrepancies.
- Communicate with healthcare providers to resolve coding and clinical clarification issues.
- Ensure compliance with DHA, HAAD, and insurance guidelines.
- Maintain high accuracy, productivity, and adherence to internal SOPs.
Qualifications & Skills
- Bachelor of Pharmacy or related healthcare degree.
- Proven experience in medical claims adjudication within TPA or insurance environments.
- Knowledge of UAE insurance regulations and payer policies.
- Proficiency in claims systems and Microsoft Office.
- Excellent analytical, communication, and documentation review skills.
