Insurance Administrative
Role Overview
Serves medical insurance customers by determining insurance coverage; examining and resolving medical claims; documenting actions; ensuring legal compliance.
Key Skills for This Role
Full Job Posting
About My Clinic
My Clinic is the leading multispecialty outpatient care provider in Saudi Arabia, with a mission to help people live longer, healthier, and happier lives.
Since 2017, My Clinic has been at the forefront of healthcare, combining innovation with a deep commitment to care, collaboration, ambition, and responsibility.
Job Summary
Serves medical insurance customers by determining insurance coverage; examining and resolving medical claims; documenting actions; ensuring legal compliance.
Primary Responsibilities
- Evaluation of the requests (investigations and medications) medically and coverage according to the Basic CCHI policy and patient insurance Table of Benefits (TOB).
- Handling the submission of requests through NPHIES and/or different insurance companies' portal within specific time.
- Follow up the reply from the insurance companies.
- Communicate with My Clinic medical team for justification if required.
- Communicate with My Clinic operation teams (Reception and customer service) the insurance companies' decisions.
- Preparation of tracker for the abnormal trend (investigations and medications) of the doctors to be helpful in awareness sessions with the doctors to decrease the medical rejection.
- A doubting for the flexible timing.
- Accountability and responsibility on wrong Policy decision.
Education / Professional Qualifications
- Good Team Worker.
- Good communication skills dealing with both internal and external customers.
- Degree educated in Medical/business related subjects.
Experts & Skills
- Excellent Command of oral and written English & Arabic.
- Proficient with Microsoft Office Suite or related software.
- Details oriented.
- Excellent communication skills.
- Excellent problem-solving skills and the ability to strategize and devise solutions.
- Outstanding analytical mindset and comfort working with numbers.
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