Claims Investigator/Adjustor

Finxecs Executive Search
  • Dubai
  • Confidential
  • 2-5 years
  • 04 Mar 2015

  • Collections/ Recovery, Compliance/ Regulatory, Operations

  • Insurance, Hospitals/ Health Care
Job Description

We are currently recruiting for a leading Medical Claims Insurance company in UAE-Dubai.

Location: Dubai .

Job Description:

- Claim processing/audit all claims/scrutiny of files

- Authorization of Cashless/reimbursement request.

- Designing adequate covers and providing appropriate consultations

- Processing claim forms, adjudicate for provision of deductibles, co-pays, co-insurance maximums and provider settlements.

- Entering claims data into the system.

- Attending to queries from Members / PICs / Providers and resolving problems that results from claim settlement.

- Performing audit of randomly selected claims to ensure quality processing and detect any frauds.

- Researching claim over-payments and request funds.

- Following adjudication policies and procedures to make sure proper payment of claims.

- Providing timely and quality customer service to members, providers, and other insurance companies .

- Coordination with hospitals & clients.

- Maintaining and preparing departmental of records.

Candidate Profile:

- Bachelors Degree / Diploma in business management or related degree with a Diploma in any of the Para-Medical Courses.

- BHMS,BAMS,MBBS willing to make career in insurance can also apply.

- Minimum one year of experience in claims management in Insurance industry or TPA Company.

- Candidates working in TPA industry will be preferred.

- Good communication and interpersonal skills.

- Ambitious with ability to work under pressure

- Motivated, enthusiastic and result focused

- Possess strong interpersonal and communication skills

- Basic knowledge of relational databases and excellent knowledge of MS Office.

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Finxecs Executive Search