Claims Supervisor, NMC Specialty Hospital Dubai UAE

NMC Healthcare is presently looking to hire suitable and qualified candidate for the job role of a Claims Supervisor. The successful aspirant will perform duties at NMC Specialty Hospital located in Dubai. NMC’s career website announced this job vacancy on 9 November 2023 and is open to all interested candidates.

Purpose of A Claims Supervisor

Overseeing and managing the efficient processing of insurance claims within established guidelines and protocols.

Duties of A Claims Supervisor

• In coordination with the revenue cycle manager implements standard operate procedures and guidelines for the insurance preapprovals.
• Ensures Insurance preapproval work is performed within the required technical and patient confidentiality standards.
• Provides leadership and guidance to insurance approval team members and address their issues or concerns.
• Act as a mentor and resource to approval team members.
• Ensure that the pre-approval requests are submitted without any delay and followed up with the Insurance companies / TPA’s in order to secure complete preapproval.
• Respond to Insurance companies / TPA queries and liaise with concerned departments without any delay.
• Responsible for receiving, evaluating and escalating second opinion cases and case management.
• Prepares reports of daily activity as requested for management and assists management in monthly reports as requested.
• Attend internal and external audits, meetings and give presentation when requested.
• Do scheduling of the insurance approval team to give sufficient insurance precertification coverage for the hospital.
• To adjust duties in case of any sudden/ emergency unplanned leaves by colleagues.
• Apply medical knowledge and best insurance practice while auditing / reviewing the claims prior submission, medical records, and other documentation essential to justify the services rendered to the patient by the healthcare facility.
• Handling resubmission of rejected claims.
• Review and audit medical claims to ensure their accuracy.
• Resubmission of rejected claims
• Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers.
• Ensure to update billing officers on time with the rejections and take corrective action to avoid such instances in future
• Handling the resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
• Submit the claims with proper codes and format to insurance companies within the stipulated time.

Qualification & Experience

• Bachelor’s degree from a recognized university.
• Minimum 5 years of experience in insurance claims management/adjudication.
• Experience in medical coding ICD, CPT, DRG and HCPCS.

Knowledge & Skills Desired

• Excellent command of oral and written English.
• Flexible and able to work under pressure.
• Excellent knowledge of Microsoft applications.
• Good communication skills.

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