Tamheer – Medical Claims Operations – Urgent Hire
  • شركة الكفاح القابضة
  • 28/04/2023
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Other Jobs
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Full Time
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Company Name

شركة الكفاح القابضة


Job Description

We are on the lookout for a motivated Tamheer – Medical Claims Operations to join our awesome team at in Jeddah.Growing your career as a Full Time Tamheer – Medical Claims Operations is an incredible opportunity to develop productive skills.If you are strong in planning, problem-solving and have the right experience for the job, then apply for the position of Tamheer – Medical Claims Operations at today! Job Description Tamheer – Medical Claims Operations Job Description Role Purpose To be fully trained and aware of claims handling process including adjudication & fraud, waste and abuse management. Moreover, ensuring that daily assigned tasks are completed withing the specified time frame in line with Bupa’s values. Key Accountabilities Process all the daily batches of claims assigned in line with medical policy and Out-patient adjudication guidelines while using his/her medical background in conjunction with the instructed guidelines. Assures that each OP claim has been processed as per the checklist of steps involving checking of physical claim (or scanned image on the document management system), and cross checking with the electronic claims data on Edge, and reflecting the right decision for every claim on the operations system. Achieve daily target in terms number of claims processed. To achieve required quality through achieving at least 95% accuracy level on monthly quality audits, in order to maintain the quality standard set for the job. Makes sound medical decisions that minimize the opportunity to be challenged by providers, and consults with the medical manager where in doubt. Reports abnormal trends of provider practice for adjudicated claims where needed. Detects and escalates FWA cases to the concerned teams in line with Claims handling guidelines. Skills Fresh Graduate. Ability to conduct business in English language. Education Bachelor's degree in pharmacy Job Location Jeddah , Saudi Arabia Job Role Medical, Healthcare, and Nursing Years of Experience Min: 0 Max: 1Benefits of working as a Tamheer – Medical Claims Operations in Jeddah:● Company offers great benefits ● Company offers career progression opportunities● Attractive package

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