Senior Medical Insurance Specialist

Senior Medical Insurance Specialist – Makkah, Saudi ArabiaWHO THIS ROLE IS FOR:Someone who understands that a denied claim usually started as a weak approval request. You've shortened approval turnaround times, cleared the "pending" queues that hold up admissions, and built pre-auth submissions strong enough that the claim behind them never gets questioned. And when a claim is denied anyway, you've written the appeal that overturned it. If you've managed volume for eight years but never moved a number, this isn't the right fit.WHAT YOU'LL OWN:Approvals / Pre-authorization• Eligibility and coverage verification before service• Preparing pre-authorization requests with clinical justification strong enough to be approved first time• Following up on pending approvals and escalating delays that block admissions or scheduled procedures• Handling urgent and emergency approvals within payer timeframes• Owning first-time approval rate and approval turnaround time as your metricsClaims / Denials• Claim review, coding accuracy, and clean-claim submission• Denial management —root-cause analysis, appeals, resubmission• Reconciliation of outstanding balances with payers and TPAs• Monthly reporting on rejection rate, approval turnaround, and days in ARMINIMUM BAR:• 8+ years covering BOTH approvals and claims in a hospital or polyclinic setting• Demonstrated results — be ready to state your first-time approval rate and rejection rate, before and after• Strong ICD-10 and CPT command; you identify a coding gap without waiting for a coder• Deep familiarity with CCHI regulations, NPHIES, payer contracts, and medical necessity criteria• Advanced Excel and hands-on HIS and payer-portal experience• Professional Arabic and English — you'll write justifications and appeals in bothPREFERRED: Coding certification (CPC / CCS), or prior experience on the payer side reviewing approvals.