Healthcare Claims Assistant

Job purpose:

Processing, verification, and evaluation of healthcare insurance claims submitted by healthcare providers. Ensure that the claim adhere to the guidelines and requirements of the GIG Gulf.

Key Responsibilities

• Claims Processing: Processing healthcare insurance claims submitted by healthcare providers, such as hospitals, Medical Centers, Clinics, and physicians. Ensure that all necessary information and documentation are included in the claim form.
• Verification: Verify the accuracy and completeness of claim information. Such as patient demographics, insurance coverage details, and medical coding.
• Documentation: Maintain detailed records of all claims received, including relevant medical records, claim forms, and supporting documents.
• Coding and Billing: Review medical codes assigned to diagnoses, procedures, and services to ensure accuracy and compliance with coding guidelines, such as ICD-10, CPT, DRG codes. Assist in the preparation of billing statements or invoices based on the claim information.
• Claims Adjudication: Assist in the adjudication process by reviewing claims for completeness, accuracy, and adherence to policy guidelines. Identify any discrepancies or issues that require further investigation or clarification.
• Communication: Maintain regular communication with healthcare providers, other departments in GIG Gulf, to provide updates on claim status, request additional information if necessary, and address any concerns or questions.
• Compliance: Ensure compliance with healthcare regulations, such as UAE (DHA, DOH, and Riayati), as well as insurance company policies and procedures. Maintain confidentiality of patient health information and adhere to privacy guidelines.
• Reporting: Prepare and maintain reports on claim activities, such as claim volumes, processing times, and reimbursement amounts. Contribute to the analysis of claim data for process improvement and decision-making purposes.

Operational & Technical Responsibilities:

• Involve in reviewing claim forms, verifying coverage, and ensuring that all required information is included.
• Following guidelines and procedures to assess the validity of claims and determine the appropriate reimbursement.
• Accurate and organized documentation is crucial in the claims process. Maintaining detailed records of all claims, including relevant medical documents, invoices, and correspondence.
• Tracking the progress of claims and ensuring compliance with legal and regulatory requirements.
• Interact with policyholders, healthcare providers, and internal stakeholders to provide updates on claim status, request additional information or clarify requirements.
• Talented in using Health-Insurance Systems to enter and track claims, retrieve relevant information, and generate reports.
• Ensure the accuracy and quality of claims processing is important to minimize errors and maintain customer satisfaction.
• Participate in quality assurance activities, such as conducting audits, reviewing claims for accuracy, and providing feedback to improve processes.

Essential Requirements:

• 2-4 Years’ experience in the medical and/or insurance field(s) required.
• In depth knowledge of health insurance industry best practices.
• Detailed understanding of the claim cycles & processes.
• Familiarity with coding systems (CPT, ICD-10, HCPCS) and medical billing procedures.
• Previous knowledge in medical processing.
• Demonstrated ability to collaborate effectively with cross-functional teams.