Job Title: Medical Claims Processor

Job Description:

Our client is seeking a dedicated and detail-oriented Medical Claims Processor to join their team in Dubai, UAE. The ideal candidate will have a background in para medical science and proven experience in the TPA or health insurance sector. You will play a vital role in handling preauthorization, claims processing, and interdepartmental support with a strong focus on quality and cost efficiency.

Key Responsibilities:

Preauthorization & Claims Management

• Process and review preauthorization and insurance claims in compliance with policy terms and within defined turnaround times (TAT).

• Evaluate existing claims handling processes and identify areas for improvement.

• Optimize workflows using automation and standardization techniques.

• Monitor KPIs such as processing accuracy and turnaround times to ensure service quality.

Documentation & User Manual Development

• Audit existing user manuals and Documented Technical Procedures (DTPs) for completeness and clarity.

• Create updated, comprehensive, and user-friendly documentation.

• Collaborate with cross-functional teams for feedback and continuous improvements.

System Optimization

• Review the Medical Library/database for usage and optimization opportunities.

• Implement automated rules and configurations to enhance processing efficiency and regulatory compliance.

Client Training & Engagement

• Evaluate and enhance client training programs related to product use, preauthorization, and claims handling.

• Design customized training modules with a focus on interactivity and feedback integration.

• Conduct engaging training sessions to improve client experience and system understanding.

Skills & Qualifications:

• Bachelor’s degree in Para Medical Sciences (Allopathic Stream required).

• 2–3 years of experience in a similar role within a TPA or health insurance organization.

• Certification in CPC, CII, LOMA, or CCS is a plus.

• Strong command of MS Office, especially Outlook, Word, and Excel.

• Good understanding of health insurance operations and industry regulations.

• Excellent verbal and written communication skills, with the ability to simplify complex information for diverse audiences.