Medical Claims Review Officer

KEY RESPONSIBILITIES: Evaluate and verify medical claims to ensure clinical accuracy and compliance with policy guidelines and regulatory standards. Review patient records, medical reports, and supporting documentation to facilitate accurate claim evaluation and processing. Provide healthcare providers with medical justifications for rejected claims in line with international and Saudi medical guidelines. Negotiate and resolve disputed claims directly with healthcare providers when required. Achieve daily claims targets as assigned by the Claims Manager approved by Head of Medical. 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.

Minimum Qualifications

Medicine Bachelor’s degree (MBBS).Licensed by the Saudi Commission for Health Specialties (SCFHS).