Reconciliation Officer

Primary Responsibilities

Audit, process, and resubmit rejected/underpaid claims after thorough investigation and justification.

Identify discrepancies in medical & technical claim denials and appeal them within deadlines to maximize revenue.

Ensure compliance with UAE insurance, HAAD, Riayati & DHA guidelines.

Meet daily productivity and quality targets with high accuracy.

Provide feedback on rejection trends to minimize future claim denials.

Process high-value and critical error claims with due diligence and proper documentation.

Train and audit claims of new joiners.

Coordinate with internal and external teams to resolve claim-related issues.

Maintain professional communication, ethical standards, and proper documentation in all processes.

Preferred candidate profile

Bachelor's Degree in Medical, Paramedical or Life Sciences field(mandatory).

48 years’ experience in medical claims processing with a provider/payer/TPA in the UAE (Northern emirates).

Minimum 2 years’ experience in handling resubmissions/reconciliation.

Strong knowledge of DHA/MOH insurance protocols, coding and denial management guidelines.

Proficiency in ICD, CPT codes, and medical auditing practices.

Advanced proficiency in MS Office (especially Excel).

Strong problem-solving, conflict-resolution, and analytical skills.

Ability to meet deadlines, maintain accuracy (98%+) and ensure compliance with coding/business rules.

Excellent communication and teamwork skills.