Description

Job Overview

We are seeking a dedicated Medical Claims Supervisor to join our team at the head office. This role focuses on overseeing the screening and processing of medical claims to ensure cost efficiency, medical necessity, and compliance with policies while preventing fraudulent activities. The ideal candidate will bring experience in managing claims within the insurance sector, particularly in third-party administration (TPA), payer, or provider settings.

Key Responsibilities

The Medical Claims Supervisor will be responsible for thorough screening of both electronic and paper claims for hospitals, clinics, and pharmacies. This includes verifying claim authorizations, insurance policy coverage, treatment necessity, and appropriate CPT coding during the review process. Managing pharmacy benefit management (PBM) issues and handling resubmitted claims will be integral parts of the role. The supervisor will also coordinate claim reconciliations with healthcare providers to resolve discrepancies.

Required Skills and Qualifications

• MBBS degree or an equivalent qualification.
• At least 2 to 3 years of experience working in TPA, insurance payer, or healthcare provider environments.
• Strong knowledge of medical claims processing, preauthorization, and UAE-specific billing rules including Diagnosis-Related Group (DRG) classifications.
• Proficiency in medical coding essentials.
• Advanced skills in Microsoft Excel for data analysis and reporting.

How to Apply

If you meet the qualifications and are interested in pursuing this opportunity, please submit your updated CV via email to careers@ngiuae.com. We look forward to reviewing your application.