Senior Medical Claims Analyst

Quality-focused role owning team-level accuracy and complex case resolution. Responsible for leading quality initiatives, resolving escalated disputes, and mentoring junior staff while contributing to policy refinement.

• || Strategic Roles & Responsibilities %

  • 10%

• || Strategic Roles & Responsibilities

• Lead quality audit initiatives and implement corrective actions

• Contribute to policy refinement based on claim pattern analysis

• Mentor and develop junior staff capabilities

• || Operational Roles & Responsibilities %

  • 90%

• || Operational Roles & Responsibilities

  • Lead quality audits for the claims team, analyzing root causes of errors
  • Implement corrective actions to reduce claim processing errors
  • Resolve escalated provider disputes involving moderate-complexity clinical determinations
  • Develop claim review checklists for high-frequency scenarios using trend data
  • Update and refine policies based on claim pattern analysis
  • Mentor junior staff on policy interpretation and dispute resolution
  • Conduct training sessions on complex claim scenarios
  • Maintain expertise in regulatory changes and industry best practices

• Minimum Education Required

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

• Professional Certifications Required

  • Professional certification (e.g., CPC, CPB) preferred

• Years of Experience

  • 4 - 6 years of progressive claims processing experience in healthcare or insurance

• Languages

  • Arabic : Advanced
  • English : Intermediate

• Functional Competencies

  • Patient Documentation
  • Procedures Knowledge
  • Hygiene

• 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.