Claims Specialist

Job Overview

Waseel is seeking a detail-oriented Claims Specialist to join our dynamic team! In this role, you will be integral in evaluating and processing medical claims to ensure compliance with company policies and regulations.

Key Responsibilities

• Review and verify the accuracy of technical (Contract, Pre-authorization, and Billing) to submit the claims by healthcare providers to ensure adherence to insurance company and NAPHEIS standards.
• Acknowledge or aware for the invalid ICD-10 and price list mapping (payer agreement and SBS NAPHEIS). 
• Process of the claims submission OP/ IP.
• Process technical claims accurately using from HIS systems.
• Respond to inquiries from healthcare providers, insurance companies, regarding claims.
• Maintain an organized workflow to ensure timely processing of claims.
• Handling the GSS and confirmation from Insurance companies.

• Previous experience in healthcare claims processing
• Knowledge of medical terminology .
• Strong analytical skills and attention to detail.
• Effective communication skills, both verbal and written.

Job Requirements

• Bachelor's degree.
• 1-3 years of experience in claims processing.
• Ability to work independently and collaboratively within a team
• Proficient in Microsoft Office.
• Certifications related to claims processing (IFCE,CII) are a plus