• Process all (Direct Billing and RI claims) the daily batches of claims assigned in line with medical policy and inpatient adjudication guidelines while using medical background in conjunction with the instructed guidelines, day-in-day-out for smooth operation of business activity.
  • Achieve daily target in terms of number of claims processed within the defined regulatory timeframe.
  • Ensure that the claims are paid as per the eligible benefit and coverage.
  • Discuss all high profile/high value claims with the claims medical manager/TL where the decision is difficult and well thought.
  • Monitor and record the medical abuse and refer the suspected fraud claims to the audit and investigation team.
  • Monitor the prices and calculation discrepancies while processing the claims and report the claims which are over invoiced and/or have unagreed service codes to the relevant network team.
  • Apply the medical skills and expertise to apply the rejections wherever applicable.
  • Assist in additional tasks whenever assigned by the claims Manager/TL.

تفاصيل الوظيفة

المجال الصناعي:
المجال الوظيفي:
مجموع الشواغر:
1 .
نوع الدوام:
الوردية الأولى في الصباح
نوع الوظيفة:
لا تفضيل
أدنى مؤهل:
شهادة بكالوريوس
اسم المؤهل:
المستوى المهني:
موظف مهني
أدنى خبرة:
3 سنوات
آخر تاريخ للتقديم:
يونيو ۱۷, ۲۰۲۴
تاريخ الاعلان:
مايو ۱۷, ۲۰۲۴

Addar Group

التوظيف / شركات التوظيف · 601-1000 موظف - الرياض

ADDAR Group consists of different divisions, which helps it to concentrate on a given business and market segment. Today we are a group with diversified business interests and having a team of more than +1000 employees with diverse experience and expertise which are deployed at various clients for the projects.

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