Senior Associate Resubmissions

Role & responsibilities

To audit & process all type of rejected claims received by the payers and resubmitting them

correctly after thorough investigation and justification.

Primary Responsibilities

Properly process and audit all type of claims received by the payers, from the medical

and insurance perspective.

• Assure meeting the daily assigned target in terms of quantity & quality.

• Report back any type of claims observation or issues that may affect the process.

• Ensure that the medical ethics are respected at all times while performing the medical

evaluation of the claims.

• Participate in developing the rules engine and the billing system by providing new ideas

or proposal in order to enhance the process.

• Contribute in developing, updating and implementing the guidelines for evaluation and

processing of medical claims, as well as policies and procedures and work instructions

related to medical claims review and processing.

• Gather relevant information to clearly describe and properly escalate issues to

supervisors and managers.

• Ensure high quality customer service and respect medical and work ethics at all times

while conducting daily tasks.

• Ensure that business decisions and processes are documented in a professional way and

the communication requirements are being adhered to in a timely and professional

manner.

• Conduct training to improve the technical, insurance and medical skills and knowledge

for team members as assigned by the supervisor or manager.

Restricted for internal use only DOC# ACCUMED-UAE/Template/HRA-HRM/7060

• Provide all the needed support as advised by the supervisor based on the business need.

• Other related tasks assigned by the line manager.

Job Requirements

• Bachelors Degree in Medicine (MBBS) or any Bachelors degree in the medical field.

• Any additional certifications related to the role will be an added advantage.

• At least 2-3 years’ medical claims processing experience with a provider / payer/ TPA in

the UAE is essential.

• Should have at least 1year experience in handling resubmissions.

• Good knowledge of insurance protocols.

• Should have good IT skills.

• Knowledge of ICD’s, CPT’s desirable