إنتهت صلاحية هذا الإعلان الوظيفي لقد إنتهت صلاحية هذا الإعلان الوظيفي و هو غير مفتوح حاليا لأي طلبات عمل.
إرفاق
وصف الوظيفة
Role Purpose:
To ensure that assigned provider’s Outpatient claims will be medically & commercially adjudicated within the specified time frame and within the targeted quality standards to achieve the business objective of delivering high quality claims statements.
Key Accountabilities:
Adjudication:
- Process all the daily batches of claims assigned in line with medical policy and adjudication guidelines while using medical his/her medical background in conjunction with the instructed guidelines, day-in-day-out for smooth operation of business activity
- Assure that each Outpatient claim has been processed as per the checklist of steps involving checking of physical claim (or scanned image on the document management system), and cross checking with the electronic claims data on CAESAR, and . reflecting the right decision for every claim on the operations system
- Achieve daily target in terms number of claims without delaying claims unnecessarily
Quality:
- To achieve required quality through achieving at least 95% accuracy level on monthly quality audits, in order to maintain the quality standard set for the job
- Makes sound medical decisions that minimize the opportunity to be challenged by providers, and consults with seniors where in doubt
- Fraud and abuse identification:
- Reports abnormal trends of provider practice for adjudicated claims where needed
- Detects and escalates fraud to the medical Unit Sections Head inline with the fraud guild lines
المهارات
Education:
Bachelor of medicine / Bachelor of surgery
Experience
Clinical Experience
Medical Insurance Experience preferable
المؤهلات العلمية
Bachelor's Degree in Pharmacy or Nursing from an accredited Institution
تفاصيل الوظيفة
المرشح المفضل
Bupa Arabia
Bupa Arabia is a healthcare insurance company based in the Kingdom of Saudi Arabia. We are an associate business of Bupa Group, which is a global healthcare company with an international reach that extends across multiple business operations, practices, and resources.
Founded in October 1997, Bupa Arabia was initially established through a partnership between Bupa Global International and Nazer Group, with the key focus to provide health insurance services with high quality and competitive prices, while ensuring a distinctive experience for customers. Bupa Arabia has since evolved into a fully Saudi-owned and operated company. Our transformation from a joint venture into a publicly traded company on the Saudi Stock Exchange occurred in 2008, as we made 40% of our shares available to the public during our Initial Public Offering (IPO).
As a subsidiary of the global Bupa Group, we draw upon international expertise while maintaining a profound understanding of local healthcare requirements and regulations. This allows us to offer comprehensive healthcare insurance solutions tailored to the unique needs of the Saudi Arabian market.
Bupa Arabia prides itself on its commitment to the wellbeing and development of its employees, providing them with the same standard of care, support, and professionalism that it expects to be delivered to its customers.
Our core values shape every aspect of our work and culture:
Commit – Own it with accountability and urgency.
Collaborate – Win together through cross-functional synergy.
Care – Put people first, both employees and customers.
