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claims analyst

MH Enterprises

<p><b>Key Responsibilities</b></p><p>1. Claim Intake, Validation &amp; Documentation</p><ul><li>Receive and log all types of claims including:</li><li>Validate claim eligibility against supplier agreements, commercial terms, and approved promotions.</li><li>Ensure claims are supported by proper documentation &mdash; debit notes, invoices, promotional agreements, sell-out reports, credit notes, proof of activity, etc.</li><li>Verify calculations, pack sizes, and quantities to ensure accuracy before submission to suppliers.</li></ul><p>2. Stakeholder Coordination &amp; Approvals</p><ul><li>Coordinate with Brand Managers / Trade Marketing to validate promotions and scheme eligibility.</li><li>Liaise with Finance &amp; Accounts for claim entries, JV postings, and accounting provisions.</li><li>Ensure all internal approvals are obtained prior to sending claims to suppliers.</li></ul><p>3. Reconciliation, Tracking &amp; Settlement</p><ul><li>Maintain a comprehensive claim tracker detailing open, approved, rejected, and settled claims &mdash; with values, dates, claim types, and supporting references.</li><li>Reconcile claim balances with supplier statements and internal ledgers.</li><li>Regularly follow up with suppliers for claim settlement (through VCINs / credit notes / cheque settlements / net-offs).</li><li>Highlight delays, aged claims, or disputed amounts to Brand / Finance leadership for escalation.</li><li>Assist in month-end closing by ensuring correct accounting of provisions for unsettled claims.</li></ul><p>4. Reporting &amp; Escalation</p><ul><li>Prepare and share weekly/monthly claim status reports with Brand Managers, Finance, and Management.</li><li>Provide visibility on claim ageing, pending approvals, rejected claims, and settlement timelines.</li><li>Escalate critical issues such as high outstanding amounts, repeated rejections, or delays beyond agreed timelines.</li></ul><p>5. Compliance &amp; Process Improvement</p><ul><li>Ensure all claims adhere to company policies, SOPs, and audit requirements.</li><li>Maintain a proper audit trail of all supporting documents, approvals, and supplier communications.</li><li>Identify process gaps and propose improvements to reduce claim processing time and financial leakage.</li><li>Support automation initiatives like ERP claim modules, digital approvals, or dashboards.</li></ul><p><b>Skills &amp; Competencies</b></p><ul><li>Strong Excel skills for claim calculations, tracking &amp; reconciliations.</li><li>Familiarity with ERP systems</li><li>Good understanding of FMCG trade terms, promotions, and supplier agreements is preferred.</li><li>High attention to detail and accuracy.</li><li>Strong coordination and follow-up skills with internal &amp; external stakeholders.</li><li>Commercial acumen and basic accounting knowledge.</li></ul><p>Job Type: Full-time</p><p>Pay: Up to AED2,500.00 per month</p>

Accounts Assistant

Marsh & McLennan Companies, Inc.

<div><span style="font-size: 11px;"><b>We will count on you to:</b></span></div><div><span style="font-size: 11px;">Escalate moderate to complex issues related to claims complications and processes to ensure accurate application of policies and calculation of claims rates.</span></div><div><span style="font-size: 11px;">Maintain and generate claims reports of moderate complexity, ensuring accurate records are produced and distributed.</span></div><div><span style="font-size: 11px;">Update, generate, review, and distribute new claim notifications/updates to all insurers for all policies or coverages, ensuring consistent availability of up-to-date information until claim completion.</span></div><div><span style="font-size: 11px;">Review and file incoming documentation from clients and underwriters, ensuring that all materials are catalogued and readily available to the team.</span></div><div><span style="font-size: 11px;">Acknowledge receipt of documentation via mail or phone to maintain professional communication with insurers, clients, and underwriters.</span></div><div><span style="font-size: 11px;"><br></span></div><div><span style="font-size: 11px;"><b>What you need to have:</b></span></div><div><span style="font-size: 11px;">Bachelor's Degree in a relevant field.</span></div><div><span style="font-size: 11px;">Minimum of 2 years of related experience in direct client service, preferably in claims (either insurer or broker).</span></div><div><span style="font-size: 11px;">Strong command of written and spoken Arabic and English.</span></div><div><span style="font-size: 11px;"><br></span></div><div><span style="font-size: 11px;"><b>What makes you stand out:</b></span></div><div><span style="font-size: 11px;">Experience in preparing and reviewing insurance claims documents for completeness.</span></div><div><span style="font-size: 11px;">Ability to identify potential policies and coverage for incoming claims and seek validation when necessary.</span></div><div><span style="font-size: 11px;">Familiarity with regulatory requirements and internal policies and procedures.</span></div><div><span style="font-size: 11px;">Willingness to attend client meetings across the UAE as needed.</span></div>

Administrator - Claims Advisory

Alliance Insurance Abu Dhabi

<b>Responsibilities</b>: <br><p>Receive, review, and process medical insurance claims submitted by policyholders or healthcare providers.</p>
<p>Adjudicate claims based on policy terms, coverage limits, and medical necessity criteria.</p>
<p>Verify the accuracy and completeness of claim forms, medical records, and supporting documentation.</p>
<p>Investigate questionable claims by contacting healthcare providers, requesting additional information or documentation, and analysing medical records.</p>
<p>Make decisions on claim approvals, denials, or requests for additional information based on investigation findings and policy guidelines.</p>
<p>Ensure timely and accurate processing of approved claims for payment, including coordinating with finance departments and third-party administrators.</p>
<p>Communicate with policyholders, healthcare providers, and internal stakeholders regarding claim status, decisions, and any required actions.</p>
<p>Maintain detailed records of claims, correspondence, and investigation outcomes in accordance with regulatory requirements and company policies.</p>
<p>Ensure compliance with healthcare regulations, coding standards (e.g., ICD-10, CPT), and company policies throughout the claims process.</p>
<p>Provide excellent customer service to policyholders and healthcare providers, addressing inquiries and resolving <b>issues related to claims.</b></p><b>
 Qualification &amp; Skills: </b><br><ul>
<li>Bachelor of Medicine, Bachelor of Surgery (MBBS), Nursing degree, or relevant medical degree from an accredited institution.</li>
<li>Experience in the relevant health insurance industry is preferred.</li>
<li>Minimum knowledge of computer skills, including proficiency in Excel and other relevant software applications.</li>
<li>Strong analytical, communication, and problem-solving skills.</li>
<li>Attention to detail and ability to work efficiently in a fast-paced environment.</li>
<li>Ability to prioritize tasks and meet deadlines effectively.</li></ul>

Senior claims officer

King's College Hospital London

<p><strong>Key Accountabilities:</strong></p>
<p><strong>Supervision and Compliance</strong></p>
<ul>
 <li>Works under the supervision of the immediate manager</li>
 <li>Comply with all the latest Joint Commission International (JCI) and Dubai Health Authority (DHA) government standards</li>
</ul>
<p><strong>Insurance Knowledge and Claims Submission</strong></p>
<ul>
 <li>Complete knowledge of insurance policies and protocols</li>
 <li>Accurate submission of claims and approvals</li>
 <li>Electronic claims (E-Claims) analysis prior to submission to insurance companies</li>
 <li>Electronic claims (E-Claims) analysis prior to submission to insurance companies by Finance</li>
</ul>
<p><strong>Claims Monitoring and Authorization</strong></p>
<ul>
 <li>Monitors the pending list on a daily basis</li>
 <li>Follow up on insurance approvals on a daily basis</li>
 <li>Monitoring and following up on prior electronic authorization for services</li>
 <li>Monitoring and follow up on prior electronic authorization for outpatient and inpatient services</li>
</ul>
<p><strong>Claims Reconciliation and Coordination</strong></p>
<ul>
 <li>Electronic reconciliation of claims paid and outstanding with insurance companies and coordination with Revenue Cycle Management (RCM) and Finance</li>
 <li>Electronic reconciliation of claims paid and outstanding with insurance companies and coordination with Finance</li>
 <li>Coordination with appropriate personnel to ensure that all the formalities agreed with the insurance companies are followed to minimize objections and avoid delays in clarifications. This includes coordination with:<br> <ul>
 <li>Patient Relations</li>
 <li>Nursing</li>
 <li>Physicians</li>
 <li>Finance</li>
 </ul>
 </li>
</ul>
<p><strong>Rejections and Problem Solving</strong></p>
<ul>
 <li>Able to answer insurance queries, analyze rejections, and process claim re-submissions</li>
 <li>Work to avoid and minimize claim rejections</li>
 <li>Identify and analyze problems, take action to resolve, apply sound judgment, and take responsibility for their resolution</li>
</ul>
<p><strong>Billing and System Management</strong></p>
<ul>
 <li>Ensure all invoices and claims are captured on the pharmacy/hospital billing system</li>
</ul>
<p><strong>Communication and Work Ethics</strong></p>
<ul>
 <li>Makes accurate, thorough, and appropriate work a priority</li>
 <li>Inform and influence others through clear, concise expression of ideas and information in verbal and written communication</li>
</ul>
<p><strong>Other Responsibilities</strong></p>
<ul>
 <li>Perform any additional duties reasonably assigned by the organization or line manager, even if not explicitly listed in this job description, to meet operational needs and support specific objectives of your department and organization</li>
 <li>Comply with all organizational and departmental policies, procedures, legal requirements, and applicable regulations at all times, and take personal responsibility to read, understand, follow and keep updated with the latest versions.</li>
 <li>Avoid and report any actions that may cause financial loss, reputational damage, or breach of trust to the organization, including fraud, dishonesty, or misrepresentation, which may result in disciplinary action, termination, and legal liability.</li>
 <li>Maintain confidentiality of all organizational, patient, client, and employee information in accordance with policies and laws.</li>
</ul>

Pharmacy Insurance Coordinator/Trainee Pharmacist

Allianz

SUMMARY The Medical Claims Officer will provide quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards. MAIN TASKS   Manages routine daily claims administration work.   Coordinates work flow &amp; meet deadlines.   Evaluates claims with regards to eligibility.   Takes decisions on high cost and complicated cases based on standard operating procedures.   Handles International Preauthorization cases as required.   Attends cal SUMMARY The Medical Claims Officer will provide quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards. MAIN TASKS   Manages routine daily claims administration work.   Coordinates work flow &amp; meet deadlines.   Evaluates claims with regards to eligibility.   Takes decisions on high cost and complicated cases based on standard operating procedures.   Handles International Preauthorization cases as required.   Attends calls and e-mails from insurance companies, clients, and providers.   Coordinates with international providers for direct billing.   Makes suggestions to improve service.   Increases efficiency, minimizes errors and administration time. BEHAVIORAL REQUIREMENTS   Organizational &amp; time management skills.   Excellent team player.   Ability to work well with all levels of internal management and staff, as well as outside clients and users.   Ability to demonstrate sound work ethics.   Show flexibility with excellent interpersonal skills.   The ability to communicate sensitively and effectively with claims department and other departments having regard for the strict need for confidentiality.   To be capable of responding diplomatically to pressures and problems showing a calm approach to working towards deadlines and always able to show an innovative and creative approach to work.   The ability to exercise initiatives and be able to work flexibly under pressure and to tight deadlines.   Experience of working with senior managers and understanding the necessity to act in a pleasant and courteous manner and to be able to work effectively with others. BEHAVIORAL COMPETENCY Customer &amp; Market Excellence:   Strive for excellence at every touch point with the customer   Foster state-of-art technical/operational knowledge and strive for continuous simplification   Be the benchmark Collaborative Leadership:   Empower the team and provide purpose and direction   Develop people, provide feedback and care to employee wellbeing   Collaborate and exchange best practice. Entrepreneurship:   Act on opportunities, anticipate trends, take risk, and promote a culture that allows for honest failure   Take ownership and responsibility   Embrace innovation and a culture that allows to make decisions without fear of retribution. Trust:   Act with integrity, honor commitments, tell the truth   Foster diversity and inclusiveness   Act transparently and promote corporate social responsibility. MINIMUM REQUIREMENTS   Bachelor's of Medicine (MBBS) only.   Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus).   Physically fit to carry out duties.   Legally permitted to work in the country of operations.   Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills 44265 | Operations | Professional | ((custPositionClusterCSB)) | Allianz Partners | Full-Time | Permanent Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams and challenges, is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow and to shape a better future for our customers and the world around us. We at Allianz believe in a diverse and inclusive workforce and are proud to be an equal opportunity employer. We encourage you to bring your whole self to work, no matter where you are from, what you look like, who you love or what you believe in. We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, disability or sexual orientation. Great to have you on board. Let's care for tomorrow.

Medical Claims Officer

WHEALTH INTERNATIONAL L.L.C

<ul><li>Analyze medical claims for accuracy, ensuring all details align with provided documentation and coding guidelines.</li><li>Investigate and resolve claim discrepancies, contacting providers and patients to gather necessary information and clarify issues.</li><li>Process claims efficiently using specialized software, meeting daily processing targets and maintaining a high level of accuracy.</li><li>Verify patient eligibility for benefits, confirming coverage details and communicating any limitations to relevant parties.</li></ul>

Medical Claims Processor

Zurich Insurance

<p>Interacts effectively with our insureds, brokers, adverse parties/carriers, witnesses, and attorneys in order to effectively complete investigations and collect assets due the company.</p><p>Interacts with national/local regulatory bureaus as needed.</p><p>Recognizes and responds to business opportunities by finding and implementing new resources and evaluating collection practices for ways to increase efficiencies.</p><p>Reviews bonds, accounting records, invoices and other required material during the investigation and recovery effort and notifies appropriate parties of outstanding issues as needed.</p><p>Networks with other teams, maintaining good communication and information sharing.</p><p>Makes the best use of resources available to ensure comprehensive solutions to collections issues.</p><p>Prepares reports outlining investigation findings, analyzes cases and recommends appropriate course of action.</p><p>Recommends and/or implements collection process improvements, integrating new concepts, approaches and attitudes while remaining focused on goals.</p><p>Monitors and controls expenses incurred on claims and salvage cases.</p>

Claims Recovery Specialist - Property

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