Senior Team Leader – Medical Claims & Approvals

Job description / Role

About ALFIT Insurance
At ALFIT Insurance, we are committed to delivering innovative, customer-focused healthcare insurance solutions. We work closely with healthcare providers, regulatory authorities, and our members to ensure reliable, transparent, and efficient services.

Role Overview
We are seeking an experienced Senior Team Leader – Medical Claims & Approvals to join our Medical Department. Reporting to the Chief Medical Officer, this role will lead and oversee medical claims assessment and pre-approval processes, ensuring accuracy, compliance, and operational efficiency. The ideal candidate will have in-depth knowledge of UAE healthcare regulations, insurance policies, and medical coding, with the ability to drive process improvements and manage stakeholder relationships.

Key Responsibilities

• Lead and supervise claims and approvals processing, ensuring compliance with DHA/DOH regulations and ALFIT policies.
• Review, validate, and adjudicate medical claims and pre-approvals with accuracy and efficiency.
• Coordinate with TPAs, healthcare providers, and internal stakeholders to resolve disputes and ensure timely approvals.
• Monitor claim rejection rates, turnaround times, and overall portfolio performance, providing regular reports to management.
• Recommend process improvements to enhance efficiency, reduce claim denials, and improve customer and provider experience.
• Ensure accurate documentation and audit-ready records in line with regulatory standards.

• Bachelor’s degree in Healthcare, Medicine, Nursing, Pharmacy, or related field.
• 5–7 years’ experience in medical claims, approvals, or health insurance operations, including at least 3 years in a senior or supervisory role.
• Strong understanding of UAE health insurance regulations and payer-provider processes.
• Solid knowledge of ICD-10, CPT coding, and claims adjudication.
• Proficiency in MS Office and healthcare claims systems (e.g., eClaimLink, Riayati).
• Excellent communication and interpersonal skills; Arabic is an advantage.

About the Company

A leading consulting company in UAE.