Claims integration (Pipeline)

Processing provider claims and applies regulator KPI in addition to execute key projects that supports the claims efficiency and other key business priorities.

Claims efficiency & Provider process:

• Received and validate providers submission through NPHIES within KPI.
• Received and validate providers documents such as invoices, approvals, and all related support documents.
• Give orientation to providers for claims guide.
• Communication with the providers and follow up in any requests, rejection and inquiries
• Ensure adherence to legal and company policies and procedures

Reporting:

• Collect and analyse data received from providers.
• Create and maintain report and dashboards to track key performance.
• Develop and implement data quality checks to ensure accuracy and consistency of data

Project Support:

• Support in planning projects and provide materials and tools to help excute NPHIES projects
• Ensure post-implementation benefits realization are reported accurately and on timely manner

Hotline & Resolve PR Complaints:

• Handle calls from providers, provide solutions related to claims submission and check the dashboard to evaluate the total calls
• Resolve PR escalated cases in timely manner

• Bachelor’s degree Business Administration or relative majors.
• Experience in health insurance field
• Proficiency in English and Arabic (spoken and written)
• Microsoft Office skills
• Communication skills
• Interpersonal skills