The Senior Claims Analyst will manage an assigned caseload of Inpatient Claims received directly from customers residing in the GCC (excluding KSA), and also from medical providers in the GCC (excluding UAE and KSA). This includes the management of claims with longer duration and evolving medical conditions. It also requires potentially complex benefit calculations on a monthly basis.

Responsibilities:
• Determine customer eligibility by reviewing contractual language and medical documentation, interpret information and make decisions based on facts presented
• Assess medical appropriateness of claims submitted, and adjust claims as needed
• Pay all covered claims accurately and timely
• Execute on all client and provider SLA agreements
• Attain individual and team quality and productivity targets
• Manage both new claims and open claims equally and maintains decision turnaround times
• Understand Cigna Operations and Corporate Compliance, Polices and Procedures and best practices • Stay abreast of ongoing training associated with role and business unit objectives

Skills
• Medically qualified, and experienced for at least 2 year as a Medical Doctor or Dentist is essential
• Minimum 3 year Claims experience in health insurance, hospital administration, and / or medical office management setting is essential
• Excellent attention to detail, quality and accuracy is essential
• Excellent organizational, workload and time management skills is essential
• Able to work within tight timeframes to achieve challenging objectives and TAT’s is essential
• Healthcare coding experience is strongly preferred
• High School Diploma or GED required - Bachelor''s degree strongly preferred
• GCC regional exposure is a (+)
• Familiarity with international guidelines and medical best practice (Milliman, NICE etc.) is a (+)
• Must have the ability to work with a sense of urgency and be a self-starter with a customer focus mind-set.
• Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously
• Proficiency with MS Office applications is required (Word, Outlook).
• Strong written communication skills demonstrated in previous work experience
• Experience in effectively meeting/exceeding individual professional expectations and team goals.• Demonstrated analytical and math skills.

Job Details
Job Location: Dubai, United Arab Emirates Company Industry: Insurance Company Type: Employer (Private Sector) Job Role: Customer Service and Call Center Employment Type: Full Time Employee Monthly Salary Range: Unspecified Number of Vacancies: Unspecified Job Ref.: JB3777987

Preferred Candidate
Career Level: Mid Career Years of Experience: Min: 3