General Overview

We are supporting one of our healthcare clients in the UAE to hire a Medical Claims Officer with solid experience in reviewing and processing IP/OP medical claims. The ideal candidate will have a strong eye for detail, good analytical skills and an understanding of medical terminology, coding and policy guidelines. This role is based at Dubai Silicon Oasis.

Key Responsibilities

• Review, evaluate and process Inpatient (IP) and Outpatient (OP) medical claims with accuracy.
• Verify policy coverage limits, coding accuracy and medical necessity in line with client guidelines.
• Ensure claims adjudication complies with established rules, standards and procedures.
• Coordinate with internal teams, TPAs and healthcare providers to obtain clarifications or missing documents.
• Detect inconsistencies, errors or potential fraud and escalate appropriately.
• Meet required turnaround time (TAT) and quali...