Medical Auditor

Submission of Hospital and Pharmacy Claims within the due date as per Insurance Contractual terms and conditions. Analyzing the rejected Claims and resubmission of the same within due date.

• Segregates finalized IP and OP bills in HIS as per the insurance company.

• Creates insurance-wise XML claim batches and submits them to DHPO.

• Receives bills from Pharmacy for PBM and Non-PBM claims, verifies them, and confirms them in ERP/Oracle.

• Creates insurance-wise XML batches for Pharmacy claims and submits Non-PBM claims in DHPO.

• Analyzes rejected claims and resubmits them in DHPO with appropriate justification.

• Communicates claim rejections to the concerned teams.

• Provides reports on claims generated, submitted, amount received, claims cost, outstanding amounts, and rejections.

• Bachelor’s degree (preferably in Nursing, Coding, or a Paramedical field) with experience in the insurance or healthcare industry.

• Fluent in spoken and written English; spoken Arabic is an advantage but not essential.

• Strong knowledge of MS Office.