Medical Insurance Senior Specialist- Riyadh

Role Overview

Medical Insurance Senior Specialist at Nahdi, based in Riyadh. This role leads and manages medical approvals, insurance claiming, and billing processes with insurance companies and credit corporate sales accounts.

Role Purpose

Lead and manage the medical approvals, insurance claiming, and billing process with insurance companies and credit corporate sales accounts while working to minimize claim rejections and collect payments within due dates to improve polyclinic profitability.

Key Responsibilities

Medical Approvals & Claims Processing

• Lead instant approvals for insurance guests.
• Review and verify claims and all required data and information.
• Examine claims, verify insurance eligibility, and record medical charges, payments, and adjustments.
• Review patient records using medical coding procedures.
• Detect coding errors and perform necessary modifications.

Insurance Operations & Analysis

• Analyze day-to-day data to improve the claiming process and operations.
• Verify and check reports matching with Waseel insurance companies' systems (Tawuniya, DHS, and Bupa).
• Update internal databases that electronically store and organize patient records, billing details, and registration forms.

Claims Negotiation & Rejection Minimization

• Communicate and negotiate with insurance companies in case of claims rejections to minimize rejections before reconciliations.

Stakeholder Communication & Coordination

• Assist patients in obtaining and understanding medical benefits.
• Communicate with other medical staff members and health insurance providers.
• Liaise with concerned departments on their medical insurance claims and finalize with other teams (Finance, IT, etc.).

Additional Duties

• Perform other duties as assigned.

Qualifications & Experience

• High School Diploma (preferably University Graduate).
• Two years in Medical Insurance.
• Experience with healthcare provider in insurance is an added advantage.

Skills & Competencies

• Microsoft Office.
• English and Arabic (fluent spoken and written).

Additional Information

• Work environment: 100% indoors.
• Schedule: 6 working days per week, 1 day off.
• Hours: 8-hour shifts to ensure continuous attendance to reception, with 1 hour rotational break.