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claims analyst

The Cigna Group

<div>We are looking for a detail-oriented claims Analyst Lead to join our insurance team. 
You will be responsible for preparing claim forms, verifying information, and corresponding with agents and beneficiaries and also handle client inquiries, review policies, determine coverage, calculate claim amounts, and process payments.
To be successful, you should have excellent organizational and interpersonal skills and also be able to work under pressure and perform a range of clerical functions with great attention to detail.
Context : Must have a Technical expertise with depth or breadth of knowledge within Claims, Responsible for researching and resolving escalated and complex claim issues in a timely manner. Identifies error trends and notifies the appropriate areas for correction, communicating/educating the necessary parties. Provides recommendations regarding process improvements. Communicates with service providers, attorneys, policyholders, and other involved parties. Provides guidance, coaching, and direction to more junior team members of the team. Acts independently working under limited supervision.
Main Duties / Responsibilities :
<ul><li>A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company.</li><li>
Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information.</li><li>
In addition, a processor must keep meticulous records of claims and follow up on lapsed cases.</li><li>
Medical claims processors are expected to have an extensive knowledge of medical terminology, as well as experience using a computer.</li><li>
Recording and maintaining insurance policy and claims information in a database system.</li><li>
Determining policy coverage and calculating claim amounts.</li><li>
Processing claims payments.</li><li>
Answering queries related to Policy coverage criteria and guidelines.</li><li>
Complying with federal, state, and company regulations and policies.</li><li>
Since medical claims processors must approve or deny payment to doctors, it is vital that they know how to correctly read and assess medical documents.</li><li>
Good communication skills are necessary to converse with doctors' offices or insurance companies if there is a problem with the claim.</li><li>
Performing other clerical tasks, as required.</li></ul> 
Requirement :
<ul><li>Medical Qualification Background will be an added advantage.</li><li>
At least 5 years of experience as a claim or in a related role.</li><li>
Knowledge of Medical Terminologies, CPT codes and ICD-9 codes.</li><li>
Working knowledge of the insurance industry and relevant federal and state regulations.</li><li>
Computer literate and proficient in MS Office.</li><li>
Excellent critical thinking and decision-making skills.</li><li>
Good administrative and organizational skills.</li><li>
Strong customer service skills.</li><li>
Ability to work under pressure.</li><li>
High attention to details</li></ul>
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we&rsquo;re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: SeeYourselfEMEA@cigna.com for support. Do not email SeeYourselfEMEA@cigna.com for an update on your application or to provide your resume as you will not receive a response.</div>

Claims Lead Analyst

<div>
 We are looking for a detail-oriented claims Analyst Lead to join our insurance team.
 
 
 You will be responsible for preparing claim forms, verifying information, and corresponding with agents and beneficiaries and also handle client inquiries, review policies, determine coverage, calculate claim amounts, and process payments.
 
 
 To be successful, you should have excellent organizational and interpersonal skills and also be able to work under pressure and perform a range of clerical functions with great attention to detail.
 
 
 
 Context :
 
 Must have a Technical expertise with depth or breadth of knowledge within Claims, Responsible for researching and resolving escalated and complex claim issues in a timely manner. Identifies error trends and notifies the appropriate areas for correction, communicating/educating the necessary parties. Provides recommendations regarding process improvements. Communicates with service providers, attorneys, policyholders, and other involved parties. Provides guidance, coaching, and direction to more junior team members of the team. Acts independently working under limited supervision.
 
 
 
 Main Duties / Responsibilities
 
 
 
 <ul>
 <li>
 A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company.
 </li>
 <li>
 Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information.
 </li>
 <li>
 In addition, a processor must keep meticulous records of claims and follow up on lapsed cases.
 </li>
 <li>
 Medical claims processors are expected to have an extensive knowledge of medical terminology, as well as experience using a computer.
 </li>
 <li>
 Recording and maintaining insurance policy and claims information in a database system.
 </li>
 <li>
 Determining policy coverage and calculating claim amounts.
 </li>
 <li>
 Processing claims payments.
 </li>
 <li>
 Answering queries related to Policy coverage criteria and guidelines.
 </li>
 <li>
 Complying with federal, state, and company regulations and policies.
 </li>
 <li>
 Since medical claims processors must approve or deny payment to doctors, it is vital that they know how to correctly read and assess medical documents.
 </li>
 <li>
 Good communication skills are necessary to converse with doctors' offices or insurance companies if there is a problem with the claim.
 </li>
 <li>
 Performing other clerical tasks, as required.
 
 
 </li>
 </ul>
 
 Requirement
 
 
 
 <ul>
 <li>
 Medical Qualification Background will be an added advantage.
 </li>
 <li>
 At least 5 years of experience as a claim or in a related role.
 </li>
 <li>
 Knowledge of Medical Terminologies, CPT codes and ICD-9 codes.
 </li>
 <li>
 Working knowledge of the insurance industry and relevant federal and state regulations.
 </li>
 <li>
 Computer literate and proficient in MS Office.
 </li>
 <li>
 Excellent critical thinking and decision-making skills.
 </li>
 <li>
 Good administrative and organizational skills.
 </li>
 <li>
 Strong customer service skills.
 </li>
 <li>
 Ability to work under pressure.
 </li>
 <li>
 High attention to details
 
 
 </li>
 </ul>
 
 About The Cigna Group
 
 
 
 Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we&rsquo;re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.
 
 
 
 Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
 
 
 
 
 If
 
 
 you require reasonable accommodation in completing the online application process, please email: SeeYourselfEMEA@cigna.com for support. Do not email SeeYourselfEMEA@cigna.com for an update on your application or to provide your resume as you will not receive a response.
 
</div>

مستشفى دار الشفاء - Dar Alshefa Hospital

<div>
 <ul>
 <li>
 
 JOB SUMMARY
 
 </li>
 </ul>
 
 The insurance doctor is responsible for managing all insurance-related activities for the hospital, ensuring that medical claims are accurate, compliant, and processed efficiently to maximize reimbursement and minimize denials. It is a hybrid role combining deep clinical knowledge, insurance expertise, data analysis, team leadership, and process improvement.
 
 
 
 
 <ul>
 <li>
 
 KEY ACTIVITIES AND RESPONSIBILITIES
 
 </li>
 </ul>
 
 
 
 <ul>
 <li>
 Evaluate and process claims in accordance with insurance policy, terms and conditions, and MNGHA policies and procedures. Review medical reports and ensure proper entry and compatibility with the services provided by the hospital.
 </li>
 <li>
 Check the accuracy of medical information with supporting documents (i.e., laboratory, pharmaceutical, radiology, etc.).
 </li>
 <li>
 Communicate with the treating physician/medical team for any clarification or completion of missing information.
 </li>
 <li>
 Escalate pending cases to the concerned department and follow up directly with Medical Services. Coordinate and follow up with the approving officer(s) on discrepancies in the official form.
 </li>
 <li>
 Collaborate with the claims section team on clinical queries/requests to reassess the claims.
 </li>
 <li>
 Collaborate and communicate with insurance company representatives, such as claims adjusters or medical reviewers, to provide additional information or clarification about the medical services provided.
 </li>
 <li>
 Develop a billing system to improve Revenue Cycle Management (RCM) and decrease the number of rejections. Report any observations related to claims that may affect the RCM.
 </li>
 <li>
 Facilitate the reconciliation process, respond to rejected claims with proper justifications in accordance with the insurance requirements, and coordinate with the insurance companies for resubmission in a timely manner.
 </li>
 <li>
 Participate in establishing, developing, and implementing guidelines to evaluate and process medical claims.
 </li>
 <li>
 Assuring requires preauthorization or prior approval for specific treatments, procedures, or medications.
 </li>
 <li>
 Collect sufficient information for each issue and escalate it to the concerned department.
 </li>
 <li>
 Provide professional advice to subordinates on all aspects of medical insurance practice and law.
 </li>
 <li>
 Assume the responsibilities of Claims Analyst as and if required.
 </li>
 <li>
 Prepare and present necessary reports and correspondences as required by the Executive Management and Senior Executive Management.
 </li>
 <li>
 Perform other job-related duties.
 </li>
 </ul>
 
 
 
 <ul>
 <li>
 
 Key Result Areas
 
 </li>
 </ul>
 
 
 
 <ul>
 <li>
 Weekly/Monthly Claims Processed
 </li>
 <li>
 Coding &amp; Documentation Accuracy
 </li>
 <li>
 Query Resolution Time
 </li>
 <li>
 Reduction in Missing Information
 </li>
 <li>
 Reduction in Claim Rejection/Denial Rate
 </li>
 <li>
 Reduction in Pending Cases
 </li>
 <li>
 Discrepancy Resolution
 </li>
 <li>
 Timely Resubmission
 </li>
 <li>
 Reduction in Write-offs
 </li>
 <li>
 Timeliness and accuracy of financial reports produced
 </li>
 <li>
 Number Reporting breaches identified
 </li>
 <li>
 Consolidations, Reporting &amp; Analysis
 </li>
 </ul>
 
 
 
 <ul>
 <li>
 
 Qualifications
 
 </li>
 </ul>
 
 
 
 
 Degree in Medicine or equivalent
 
 
 
 
 <ul>
 <li>
 
 Technical Skills
 
 </li>
 <li>
 Knowledge of CBAHI, Ministry of Health care policy and procedure.
 </li>
 <li>
 Knowledge of the health care sector.
 </li>
 <li>
 Knowledge of Medical coding, billing process and Clinical Documentation for RCM
 </li>
 <li>
 Clinical Understanding
 </li>
 <li>
 Work-stream leads, subordinates, healthcare team, physicians, insurance companies
 </li>
 <li>
 High paced environment with intense deadlines
 </li>
 <li>
 Great deal of details and accuracy
 </li>
 </ul>
 
 
 
 <ul>
 <li>
 
 Behavioural Skills
 
 </li>
 <li>
 Attention to Detail
 </li>
 <li>
 Professional Communication
 </li>
 <li>
 Analytical Skills: Ability to analyse denial trends and identify root causes
 </li>
 <li>
 Problem-Solving: Proactive in creating solutions to prevent future claim rejections
 </li>
 <li>
 Persistence &amp; Follow-up: Tenacity in managing the appeals and resubmission process.
 </li>
 <li>
 Business Acumen
 </li>
 <li>
 Strategic Thinking
 </li>
 <li>
 Leadership Skills
 </li>
 <li>
 Ethical and Personal Integrity
 </li>
 </ul>
</div>

Insurance Doctor

Bahri | البحري

<div>
 
 
 Job Purpose:
 
 
 
 Manage the Claims process and ensure it is communicated, followed up and settled in an efficient and timely manner as per the insurance guidelines.
 
 
 
 
 
 
 Key Accountabilities:
 
 
 
 
 
 
 Claims Process:
 
 
 Register claims with relevant stakeholders, validate the insurance against the set policies and determine the claim size. Track claims from submittal to settlement. Conduct provider negotiations for insurance claims.
 
 
 Manage and handle all insurance claims such as P&amp;I, HH&amp;M, GC, Crew, Legal&hellip;etc. Review and study contracts and reports to make effective claims management decisions. Liaise with P&amp;I Clubs, Lawyers, agents network, Surveyors and Underwriters. Act as a technical expert in the insurance claim area.
 
 
 
 
 
 Relationship Management:
 
 
 Build and maintain strong relations with legal entities P&amp;I Clubs, H&amp;M Underwriters, Loss Adjuster and Brokers to ensure seamless business support.
 
 
 
 
 
 Reconciliation:
 
 
 Reconcile claim&rsquo;s summary for the Manager&rsquo;s review in order to validate correct measures.
 
 
 
 
 
 Concepts &amp; Policies:
 
 
 Define insurance claims guidelines and procedures to mitigate risk exposure and cost of insurance claims. Adopt and apply new professional strategies and policies within the area of responsibility in accordance with management directions.
 
 
 
 
 
 Risk Management:
 
 
 Identify and mitigate risk exposure for all insurance matters and related to P&amp;I and H&amp;M Policies.
 
 
 
 
 
 
 Qualifications and Experience:
 
 
 
 Bachelor degree in Insurance Claims, Risk Management or equivalent.
 
 
 Minimum 4 years of relevant experience in Claims handling and Loss prevention.
 
 
 
 
 
 
 Professional Certificates and Licenses:
 
 
 
 Qualification from The Chartered Insurance Institute (CII) is preferred.
 
</div>

Claims Specialist

ABYAT

<div>
 
 
 Role Purpose:
 
 
 
 To support the management of claims related to project contracts, delays, cost variations, and other project-related disputes. The Claims Officer ensures timely documentation, analysis, and reporting of all claim-related matters while helping protect the organization&rsquo;s contractual and financial interests.
 
 
 
 
 
 
 Roles &amp; Responsibilities:
 
 
 
 
 
 <ul>
 <li>
 Prepare and compile all required documentation for claims, including time impact analyses, cost justifications, and supporting correspondence.
 </li>
 <li>
 </li>
 <li>
 Gather and analyze project records, reports, and schedules to identify claim entitlements.
 </li>
 </ul>
 
 
 
 <ul>
 <li>
 Assist in reviewing contract terms to identify rights and obligations related to claims.
 </li>
 </ul>
 
 
 
 <ul>
 <li>
 Assist in drafting, submitting, and tracking claims to clients, subcontractors, or vendors.
 </li>
 </ul>
 
 
 
 <ul>
 <li>
 Coordinate with legal or management teams to support the resolution of disputes or negotiations.
 </li>
 </ul>
 
 
 
 <ul>
 <li>
 Ensure that claims are raised in line with applicable contract terms, company policies, and regulatory requirements.
 </li>
 </ul>
 
 
 
 <ul>
 <li>
 Maintain claims register and generate periodic status reports.
 </li>
 </ul>
 
 
 
 <ul>
 <li>
 Liaise with project teams, subcontractors, and relevant departments for information gathering and clarification.
 </li>
 </ul>
 
 
 
 
 
 Knowledge and Experience:
 
 
 <ul>
 <li>
 2&ndash;4 years of experience in contract administration or claims within engineering, construction, or industrial sectors
 </li>
 <li>
 Familiarity with contractual frameworks (e.g., FIDIC) and claims handling procedures
 </li>
 <li>
 Basic knowledge of project scheduling and cost control
 </li>
 </ul>
 
 
 
 
 
 Education and Certifications:
 
 
 <ul>
 <li>
 Bachelor's degree in Engineering, Business Administration, Law, or related field
 </li>
 <li>
 Certification in Contract or Claims Management is a plus (e.g., CCM, PMI-CP)
 </li>
 <li>
 Proficiency in MS Office (especially Excel, Word), and document management systems
 </li>
 </ul>
</div>

Claims Officer

لدله الصحية

<div><div><div><div><h4 class="jobSectionHeader">CLAIMS OFFICERFull Time</h4></div><div>
Posted On: Wednesday, October 8th, 2025</div></div></div><div><div>
Description</div><div>
Ensures that claims (bills) for the companies are properly prepared, thoroughly checked and presented in a timely manner. 
 
Receives all OPD and inpatient invoices daily. 
Sorts the invoices in the primary classification of the companies, with sub-sorting to the file numbers within the company categories. 
Ensures that referral letters, insurance claim forms, all result of investigations, details of inpatient and discharge summary are in proper order, Insurance ID cards are updated. 
At the end of the month, or as required for any period, checks the invoices against the computer printout and prepares the claims. 
Ensures that the claims are recorded, copies are filed correctly, and arranges for the originals to be sent to the respective companies. 
Receives any returns or rejected claims, performs a check analysis and reports on them to the Supervisor for appropriate action. 
Fully aware and actively implement the departmental policies and procedures, local and international standards or requirements related to the department. 
Actively involves in indicator development, data collection for the department and to measure the performance of the function, process, and outcome. Whenever required, conducts analysis and interpretation of data/information collected. 
Participate in hospital Safety Management &amp; Risk Management Programs. Actively reports incidents in the system and whenever needed, participates in incident review, and root cause analysis. 
Performs any other duties within the range of his/her competence, as directed by the Revenue Cycle Director.</div></div><div><div>
Requirements</div><div>
Minimum 2 years post-qualification experience 
Bachelor Degree in Accountancy / Commerce Management, or any related course.</div></div><div><div>
Summary</div><div><div><div><div>
Industry:</div><div><div>
Healthcare</div></div></div></div></div></div><div>
Required Skills<div>
Communication
Ability To Operate Computers And Various Software Programs
Computer Literate
Customer Service Skills
Adaptability
Possessing A Positive
Dependability And Responsibility
Good Communication Skills In English And Arabic Languages
Honesty And Integrity
Knowledge Of Rules And Regulation Rulings Billing An Reimbursement
Strong Work Ethic
Motivated To Grow And Learn
Strong Self-Confidence
Interpersonal/Human Relations Skills.
Self-Motivated</div></div><div>
Languages<div>
EN - Professional Working Proficiency</div></div></div>

CLAIMS OFFICERFull Time

Integrated International

Contracts &amp; Claims ManagerKey Requirements:<ul><li>Solid experience in handling PIF contracts.</li><li>Solid experience in the field of construction.</li><li>Proven track record of successfully delivering large-scale projects.</li><li>Previous experience with Red Sea Global projects is highly preferred.</li><li>Strong background in contracts administration, claims management, and dispute resolution.</li><li>Excellent communication, negotiation, and leadership skills.</li></ul>Responsibilities:<ul><li>Oversee contract management and claims processes throughout project lifecycle.</li><li>Provide expert advice on contractual rights, obligations, and risk management.</li><li>Prepare and evaluate claims, variations, and contractual correspondence.</li><li>Ensure compliance with contractual and legal requirements.</li><li>Collaborate with project teams, consultants, and stakeholders to resolve disputes.</li></ul>Location: Saudi ArabiaIf you meet the above criteria and are ready to take on a challenging role with a leading organization, please send your CV to: career@redconinternational.comJob Type: Full-timeApplication Question(s):<ul><li>Do you have a transferrable Iqama?</li><li>Your Current Salary?</li><li>Do you have experience with PIF contracts?</li></ul>

Contracts & Claims Manager

Explore 195+ Claims analyst in Riyadh this October. Find roles across top companies and apply now to boost your career.

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