SENIOR MEDICAL CLAIMS ANALYST.

Job Title

SENIOR MEDICAL CLAIMS ANALYST.

Job Family

Function

Corporate

Job Code

30009907

Reports to Job

Unit Manager

Job Description Summary

Quality-focused role owning team-level accuracy and complex case resolution. Responsible for leading quality initiatives, resolving escalated disputes, and mentoring junior staff while contributing to policy refinement.

Strategic Roles & Responsibilities %

10%

Strategic Roles & Responsibilities

• Lead quality audit initiatives and implement corrective actions

• Contribute to policy refinement based on claim pattern analysis

• Mentor and develop junior staff capabilities

Operational Roles & Responsibilities %

90%

Operational Roles & Responsibilities

• Lead quality audits for the claims team, analyzing root causes of errors
• Implement corrective actions to reduce claim processing errors
• Resolve escalated provider disputes involving moderate-complexity clinical determinations
• Develop claim review checklists for high-frequency scenarios using trend data
• Update and refine policies based on claim pattern analysis

• Mentor junior staff on policy interpretation and dispute resolution
• Conduct training sessions on complex claim scenarios

• Maintain expertise in regulatory changes and industry best practices

Minimum Education Required

Bachelor degree in healthcare administration, business, or related field

Professional Certifications Required

Professional certification (e.g., CPC, CPB) preferred

Years of Experience

4-6 years of progressive claims processing experience in healthcare or insurance

Languages

Arabic : Advanced

English : Advanced

Functional Competencies

• Accounts Receivable
• Billing Investigations
• Billing Statement Preparation

Core Competencies

• Excellence
• Integrity
• Accountability
• Cybersecurity
• Person-Centered Care

Acknowledgement

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Addendum Title

Supplemental Work/Experience/Education Information

Addendum Description