Medical Claim Senior Assessor

Job description / Role

Key responsibilities / what you do:

Review and assess medical claims for both inpatient and outpatient services to determine coverage eligibility and compliance with policy terms.
Validate Diagnosis-Related Group (DRG) coding for inpatient admissions using ICD-10-CM and CPT standards, ensuring alignment with clinical documentation.
Apply thorough knowledge of UAE healthcare billing regulations, including DHA, DOH, and MOH guidelines, to ensure claims meet local compliance standards.
Identify and rectify incomplete or inaccurate claim submissions. Ensure all required documentation is present and properly coded aligning with policy guidelines.
Notify payers regarding claims that exceed predefined financial thresholds, ensuring timely communication and resolution.
Track and maintain both quantitative (volume) and qualitative (accuracy) metrics for claims processing.
Achieve assigned daily processing targets while maintaining high levels of accuracy and efficiency.
Collaborate with internal departments to resolve claim-related queries.
Perform other responsibilities as assigned by the department lead, in line with the scope of the role.

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!