To manage the end-to-end claims reimbursement process efficiently and accuratelyensuring timely claim submission, verification, adjudication, and resolution—while maintaining compliance, improving customer satisfaction, and contributing to the organization’s operational excellence.

Skills

• Claims Processes
• Documentation
• Dispute Resolution
• Claims Management
• Underwriting

Requirements

• Job Role Operations Consultant - UAE Medical Claims Reimbursements
• Job Type Full Time
• Workplace Type Onsite
• Industry Outsourcing and Offshoring Consulting

Secondary locations

About

Not provided

Responsibilities

1. Claim Submission

• Initiation: The insured individual or the service provider submits a claim to the insurance company for reimbursement.
• Required Documentation:
• Policy details (policy number, coverage specifics).
• Proof of service or expense (invoices, bills, or receipts).
• Supporting documents (e.g., medical reports, repair estimates, or loss reports).
• Submission Channels: Claims can be submitted via online portals, email, fax, or physical mail, depending on the insurer's requirements.

2. Claim Verification and Validation

• Eligibility Check:
• Determine if the claim is within the policy coverage limits and terms.
• Verify that the claim type (medical, property damage, etc.) is covered under the insured's policy.
• Document Review:
• Confirm all necessary documents have been provided.
• Ensure the claim is free from errors, fraud, or inconsistencies.
• Request for Additional Information:
• If documents are missing or unclear, the insurer requests clarification or additional evidence.

3. Claim Adjudication

• Assessment of Claim:
• Evaluate the claim amount against the policy terms and coverage limits.
• Check deductibles, co-pays, and exclusions outlined in the policy.
• Reimbursement Calculation:
• Determine the payable amount after accounting for policy conditions like sub-limits, deductibles, or co-insurance clauses.
• Approval or Denial:
• Approve valid claims for reimbursement.
• Deny claims with proper reasoning if they fall outside policy coverage.

4. Reimbursement Processing

• Payment Authorization:
• Approved claims move to the payment stage after final authorization by the claims manager or automated systems.
• Payment Methods:
• Payments are issued via direct deposit, checks, or transfers to the insured or service provider, depending on the arrangement.
• Notification:
• The claimant receives a notification detailing the reimbursement amount, processing timelines, and any deductions applied.

5. Dispute Resolution (if applicable)

• Denial Appeals:
• If a claim is denied, the insured can appeal the decision with additional documentation or clarification.
• Resolution of Discrepancies:
• Address issues such as underpayments or errors in processing through negotiation or review.
• Customer Support:
• Insured parties can work with claims specialists to resolve questions about their claim or reimbursement status.

6. Final Documentation and Archiving

• Record Keeping:
• All claim-related documents and correspondence are archived for compliance and future reference.
• Regulatory Reporting:
• Ensure claims are processed in compliance with loca

Other Requirements

Good to have

Not provided

About the Company

A world where outsourcing meets excellence – welcome to HTIC Global! We stand as a beacon of excellence in the outsourcing landscape of Dubai, UAE. Renowned for our commitment to quality & client satisfaction, we take pride in being one of the best outsourcing company in the UAE region. With a dedication to delivering exceptional services, we have emerged as a trusted partner in sectors like - travel, aviation, financial consultancy, insurance, etc.