Claims / Approvals Specialist

Job Title: Claims / Approvals Officer

Department: Medical Claims / Insurance Approvals
Location: [Riyadh, Saudi Arabia]
Reports to: Claims Manager / Approvals Supervisor

Job Purpose:

To review, process, and validate medical claims and approval requests in accordance with company policies and insurance guidelines, ensuring accuracy, compliance, and timely decision-making to support operational efficiency and customer satisfaction.

Key Responsibilities:

• Review and assess medical claims and pre-approval requests submitted by healthcare providers.
• Ensure all claims are compliant with insurance policies, coverage limits, and contractual agreements.
• Coordinate with medical teams and insurance companies to verify medical necessity and eligibility.
• Approve or reject claims based on established criteria and documentation.
• Maintain accurate records of claims decisions and approvals in the system.
• Respond to inquiries from internal departments, providers, and insurers regarding claim status.
• Identify and escalate suspicious or fraudulent claims for further investigation.
• Support continuous improvement of claims processing procedures.
• Ensure timely processing to meet service level agreements (SLAs).

Qualifications:

• Bachelor’s degree in healthcare administration, Insurance, Business, or a related field.
• Knowledge of medical terminology, insurance policies, and healthcare procedures.
• Language Requirement: Fluency in both Arabic and English (spoken and written) is mandatory.

Experience:

• 2–4 years of experience in medical claims processing, insurance approvals, or healthcare administration.
• Familiarity with claims management systems and electronic health records (EHR).
• Experience working with insurance companies or third-party administrators (TPAs).
• Understanding of regulatory and compliance standards in healthcare claims.

Soft Skills:

• Attention to Detail: Ensures accuracy in claim reviews and documentation.
• Analytical Thinking: Evaluates complex medical and insurance data to make informed decisions.
• Communication Skills: Effectively communicates with providers, insurers, and internal teams.
• Time Management: Handles multiple claims and approvals within tight deadlines.
• Integrity and Confidentiality: Maintains discretion and ethical standards in handling sensitive information.
• Problem-Solving: Resolves claim discrepancies and approval issues efficiently.
• Customer Service Orientation: Responds professionally to inquiries and ensures stakeholder satisfaction.
• Adaptability: Works well in a fast-paced and evolving regulatory environment.

Job Types: Full-time, Contract
Contract length: 12 months

Pay: ﷼5,500.00 - ﷼7,500.00 per month