Claims Processing & Auditing Manager-Yemen- Aden
- Aden, Yemen
Posted In 17/11/2018
Location: Cairo & Yemen- Aden
Job Title: Claims Processing & Auditing Manager
Reporting to: Managing Director
The Claims Processing & Auditing Manager will be responsible of the following functions:
1. Evaluation, revision and validation of claims if needed, reviewing and auditing processed claims on daily basis as per the directions of managing director.
2. Reporting the audit results and reports to the medical & claims manager.
3. Entering and processing / adjudicating claims (international claims) in company operational software system as per the terms and policy of the organization (as per the Policy Terms & Conditions & as per the Agreed Procedures per every client - payer).
4. Notification of claims shortfalls, requesting, rectifying/justifying and following up with providers (regarding International claims).
5. Maintaining both qualitative and quantitative claims measures (regarding International claims).
6. Communication with the international providers regarding the issues that belong to the batches received & processed for the international providers. Ensure the proper communication and implementation of new formats, training and processing rules as and when available (regarding International claims).
7. Perform any other tasks as may reasonably be required by your supervisor and/or manager.
8. Hiring and training staffers in the claims department and overseeing their day-to-day performance.
9. All the Targets can be Changed & Adjusted as per the Organization Strategy & Goals through the Organization Management.
Note: As a part of the first employed at our start-up company, the incumbent will be responsible of/assisting in the generation and application of test scenarios for accepting the TPA software, and will sign off on some of the modules in the software acceptance test.
If you are interested kindly send your updated CV to
2. 7-10 years of experience in management and claims / medical reports and hospital bills management experience.
3. Preferred: multinational medical experience.
4. Preferred: with insurance company and third-party administration (TPA).
5. Priority: has actually worked in insurance
6. Preferred: Master degree and/or worked as GP or emergency doctor.
7. Excellent written and spoken English & Arabic, and excellent computer skills.
About The Company
Master HR (Recruitment, HR Consultation Services, Training, Development & Outsourcing).
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