Claims Associate Analyst
Core
Process medical insurance claims and pre-approvals for providers and payers within NHS software systems, ensuring adherence to regulatory guidelines and policy coverage.
Role type
Claims Associate Analyst
Builds
Claims processing and adjudication cycle
Domain
Healthcare insurance / Medical coverage
Required skills
Claims adjudication, Medical necessity assessment, Regulatory compliance (MOH/DHA/HAAD), Database maintenance, Policy interpretation, Eligibility verification
Preferred skills
Healthcare/Hospital experience, Insurance industry background, Arabic language proficiency
Technologies
NHS operational software system
Responsibilities
Issue online and verbal authorizations based on member coverage and medical justification, Process and adjudicate claims in line with policy coverage and medical necessity, Maintain files for authorizations and reports, Monitor and maintain the claims processing cycle, Ensure adherence to predefined TATs for claims and pre-approvals, Assist queries from providers and payers via phone or email
Seniority
Junior to Mid-level, hands-on IC