Overview
Medical Claims Review Officer Jobs in Riyadh, Saudi Arabia at Saudi Arabian Cooperative Insurance Company (SAICO)
- Evaluate and verify medical claims to ensure clinical accuracy and compliance with Policy Coverage and Medical guidelines.
- Review patient records, medical reports, and supporting documentation to facilitate accurate claim adjudication.
- Provide healthcare providers with medical justifications for rejected claims in line with international and Saudi medical guidelines.
- Negotiate and resolve disputed claims directly with Medical Service Providers when required.
- Collaborate with other departments to verify claim amounts, status, and related information.
- Support efficient, accurate, and compliant claims management through timely decision-making and communication.
- Achieve Key Performance Indicators (KPIs)
- Participate in Learning & Development activities and complete a minimum of 25 training hours to maintain clinical, operational, and insurance knowledge.
- Participate in Company Projects.
- Licensed by the Saudi Commission for Health Specialties (SCFHS).
- 2-3 years of relevant experience post-graduation in medical claims review, clinical assessment or healthcare-related roles.
- Familiarity with insurance claim processes and healthcare regulations.
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Title: Medical Claims Review Officer
Company: Saudi Arabian Cooperative Insurance Company (SAICO)
Location: Riyadh, Saudi Arabia
Category: