The Senior Claims Associate will be responsible for vetting all claims submitted by our providers to ensure they are error and fraud-free. They will manage claims payment and be involved in the resolution of medical cases requiring special attention.

Job Description

• Process Healthcare Providers’ Claims using the Claims Management Process standard procedure.
• Receive and review approved Claims from Claims Operation Associates for final approval and payment.
• Investigate complicated claims and pass resolutions based on company policy and clinical standards of care
• Review complex medical cases escalated by the Customer Service Representatives in a timely manner.
• Provide quality assurance for claims management
• Provide supervisory and technical support to the manual claim operations team
• Participate in provider reconciliation and complaint resolution
• Update Providers’ dashboard and implement resolutions.
• Translate claim documents from Arabic to English and vice versa as required
• Decline fraudulent Healthcare Providers’ Claims and state causative reasons
• Receive and collate reports of suspected fraud, waste and abuse from claims associates and other stakeholders
• Investigate suspected fraud, waste and abuse and prepare an evidence-based report for final review by claim and provider operations leads.
• Relate with technology team on any update on the processes regarding the claims of Providers.
• Audit and update the standard procedure for claims management and other related SOPs