Medical Claims Officer

Job description / Role

Main tasks

Daily extraction of inpatient report for cases within assigned region and daily assessment and evaluation of cases.

Investigate inpatient cases in order to get the correct picture with justification including management plan and to follow thoroughly serious cases even though already approved.

Coordinate with site delegates to manage and prepare daily inpatient report.

Provide a unified and standardized roving reports on daily basis. Consolidated weekly reports for visited inpatient cases and savings achieved are provided by the end of each week and by the end of each month.

Coordinate for cost containment and savings measures including special discounts, transfer to low class/cost provider and case transfer to home country.

In case of suspicious activities, data shall be collected and relevant function shall be informed for their necessary actions, e.g. fraud, waste, and abuse (FWA), pre-certification, and others.

Approve urgently required services or procedures according to standard medical practice and evidence-based medicine.

Follow medical guidelines, practices and regulator (IA) instructions.

Minimum requirements

• Bachelor of Medicine and Bachelor of Surgery (MBBS)
• 3+ years of experience in a mid-to-large sized organization in a similar role
• Saudi Commission for Health Specialties (SCFHS) certification
• Typing and communication skills in English and Arabic
• Clean and valid driving license
• Physically fit to carry out duties
• Legally permitted to work in the country of operations
• Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills

About the Company

With over 159,000 employees from 172 nationalities across more than 70 countries, we are one of the world's most trusted insurance and asset management companies. We offer a broad range of products and services in property/casualty insurance, life/health insurance, and asset management. We have our largest operational presence in Europe, and our parent company, Allianz SE, is headquartered in Munich, Germany. From jobs in Actuarial, Business and IT to Inhouse Consulting and Investment Management - your opportunities are endless!