Medical Insurance Officer (Clinical Background Required)

Medical Insurance Officer (Clinical Background Required)

Location: Hurghada / Marsa Alam, Egypt

Reports to: Revenue Cycle / Finance

About the Role

We are seeking a detail-oriented and clinically trained Medical Insurance Officer to manage insurance approvals, claims processing, and coordination with insurance companies and TPAs. The ideal candidate will bridge clinical knowledge with administrative efficiency to ensure timely approvals, accurate claims submission, and optimal reimbursement for services provided.

Key Responsibilities

Review and process medical insurance approvals for outpatient, inpatient, and procedures

• Liaise with insurance companies and Third-Party Administrators (TPAs) for pre-authorizations and claim submissions
• Verify patient eligibility, coverage limits, and policy details
• Ensure accurate clinical documentation to support approvals and claims
• Prepare, submit, and follow up on insurance claims to ensure timely reimbursement
• Handle claim rejections and denials, including appeals and resubmissions
• Coordinate closely with physicians, nurses, pharmacy, and billing teams to ensure compliance with insurance requirements
• Maintain up-to-date knowledge of insurance policies, payer requirements, and coding standards
• Monitor and track approvals, claims status, and payments
• Ensure compliance with local regulations and payer agreements
• Support revenue cycle optimization by minimizing claim errors and delays
• Generate reports on approvals, claims, denials, and revenue performance

Qualifications & Requirements

• Clinical background required: Physician, Pharmacist, or Nurse
• 2–5 years of experience in medical insurance, claims management, or TPA operations
• Strong understanding of medical terminology, clinical procedures, and treatment plans
• Knowledge of insurance processes, approvals, and reimbursement systems in Egypt
• Familiarity with ICD coding, billing systems, and healthcare documentation standards is an asset
• Excellent communication skills for dealing with providers and insurance representatives
• Strong attention to detail and analytical skills
• Ability to manage multiple cases and meet deadlines
• Proficiency in Microsoft Office and hospital/insurance systems
• Fluency in English and Arabic

Key Competencies

• Clinical judgment combined with administrative accuracy
• Strong problem-solving and negotiation skills
• Ability to work under pressure in a fast-paced environment
• High level of integrity and confidentiality
• Team collaboration and coordination

What We Offer

Competitive salary and benefits

• Opportunity to work in a growing healthcare organization
• Exposure to diverse insurance networks and systems
• Career development and advancement opportunities

l How to Apply

Medical Insurance Officer (Clinical Background Required)

Location: Hurghada / Marsa Alam, Egypt

Reports to: Revenue Cycle / Finance Manager

About the Role

We are seeking a detail-oriented and clinically trained Medical Insurance Officer to manage insurance approvals, claims processing, and coordination with insurance companies and TPAs. The ideal candidate will bridge clinical knowledge with administrative efficiency to ensure timely approvals, accurate claims submission, and optimal reimbursement for services provided.

Key Responsibilities

• Review and process medical insurance approvals for outpatient, inpatient, and procedures
• Liaise with insurance companies and Third-Party Administrators (TPAs) for pre-authorizations and claim submissions
• Verify patient eligibility, coverage limits, and policy details
• Ensure accurate clinical documentation to support approvals and claims
• Prepare, submit, and follow up on insurance claims to ensure timely reimbursement
• Handle claim rejections and denials, including appeals and resubmissions
• Coordinate closely with physicians, nurses, pharmacy, and billing teams to ensure compliance with insurance requirements
• Maintain up-to-date knowledge of insurance policies, payer requirements, and coding standards
• Monitor and track approvals, claims status, and payments
• Ensure compliance with local regulations and payer agreements
• Support revenue cycle optimization by minimizing claim errors and delays
• Generate reports on approvals, claims, denials, and revenue performance

Qualifications & Requirements

• Clinical background required: Physician, Pharmacist, or Nurse
• 2–5 years of experience in medical insurance, claims management, or TPA operations
• Strong understanding of medical terminology, clinical procedures, and treatment plans
• Knowledge of insurance processes, approvals, and reimbursement systems in Egypt
• Familiarity with ICD coding, billing systems, and healthcare documentation standards is an asset
• Excellent communication skills for dealing with providers and insurance representatives
• Strong attention to detail and analytical skills
• Ability to manage multiple cases and meet deadlines
• Proficiency in Microsoft Office and hospital/insurance systems
• Fluency in English and Arabic

Key Competencies

• Clinical judgment combined with administrative accuracy
• Strong problem-solving and negotiation skills
• Ability to work under pressure in a fast-paced environment
• High level of integrity and confidentiality
• Team collaboration and coordination

What We Offer

• Competitive salary and benefits
• Opportunity to work in a growing healthcare organization
• Exposure to diverse insurance networks and systems
• Career development and advancement opportunities

How to Apply

Please send your CV to:

Subject: Medical Insurance Officer – Hurghada

Please send your CV to: coo@healthcareig.com

Subject: Medical Insurance Officer – Hurghada

Job Type: Full-time

Ability to commute/relocate:

• Hurghada: Reliably commute or planning to relocate before starting work (Preferred)

Work Location: In person