MEDICAL CLAIMS ANALYST - Roving physician

Job Title

MEDICAL CLAIMS ANALYST

Job Family

Function

Corporate

Job Code

30009906

Reports to Job

Unit Manager

Job Description Summary

Independent contributor role focused on specialized claims adjudication and pattern recognition. Responsible for handling trend-based claims while identifying process improvements and serving as a resource for junior staff.

Strategic Roles & Responsibilities %

5%

Strategic Roles & Responsibilities

• Identify emerging claim patterns and propose minor process improvements

• Contribute to workflow optimization through trend analysis

Operational Roles & Responsibilities %

95%

Operational Roles & Responsibilities

• Independently review specialized and trend-based medical/dental claims
• Apply clinical and policy knowledge to complex scenarios
• Identify patterns in claim data and propose process improvements
• Conduct self-audits on 10% of own work for accuracy against clinical guidelines
• Draft initial responses to provider disputes for supervisor review
• Serve as resource for Level 1 staff on common claim scenarios
• Maintain expertise in current policy and clinical guidelines

Minimum Education Required

Bachelor degree in healthcare administration, business, or related field preferred

Professional Certifications Required

-

Years of Experience

2-4 years of claims processing experience in healthcare or insurance

Languages

Arabic : Advanced

English : Advanced

Functional Competencies

• Accounts Receivable
• Billing Investigations
• Billing Statement Preparation

Core Competencies

• Excellence
• Integrity
• Accountability
• Cybersecurity
• Person-Centered Care

Acknowledgement

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Addendum Title

Supplemental Work/Experience/Education Information

Addendum Description