مسؤول أول خدمات التأمين

Overview

M42 delivers comprehensive healthcare services across the full continuum of care; from primary care to advanced specialty treatments. Leveraging cutting-edge health technologies and precision medicine, we ensure the highest standards of effectiveness, efficiency, and patient-centered outcomes. With a global presence spanning more than 480 facilities in 27 countries and a dedicated workforce of over 20,000 professionals, M42 is uniquely positioned to redefine the future of healthcare on a global scale.

Amana Healthcare is a leading long-term care and rehabilitation provider in the Middle East and GCC, and the region’s pioneer in post-acute care services. It offers comprehensive long-term care, post-acute rehabilitation, transitional care, and home healthcare. As part of the M42 network, Amana is dedicated to delivering high-quality, patient-centered care tailored to the needs of individuals requiring complex or extended recovery support.

The Senior Officer, Insurance Service, reports to the Supervisor, Insurance Services, and plays a key role in supporting the finance and insurance teams with daily insurance activities. These activities encompass various tasks, including
but not limited to authorization, submission, resubmission, and processing of medical claims. The Senior Officer ensures that all insurance-related activities are carried out in alignment with MH's relevant insurance procedures and
guidelines. Their expertise and dedication contribute to the smooth functioning of insurance operations and efficient patient care.

Responsibilities

• Ensure high accuracy in claims processes for insurance and corporate review, adhering to contractual agreements for efficient reimbursement.
• Coordinate with insurance companies for eligibility verification, payment approvals, and reconciliation.
• Provide customer service support for insurance verification, eligibility, and preauthorization.
• Accurately liaise with staff to ensure timely entry of insurance information and benefits.
• Verify claims compliance with billing guidelines.
• Coordinate with doctors and senior officers to provide updates and training on insurance and billing guidelines.
• Communicate insurance guidelines and procedures to front-line staff.
• Support other departments and payers in tracking payments.
• Monitor receivables and conduct financial reconciliation for remittance advice.
• Maintain proper records and files for claims correspondence with insurance and private or corporate businesses.
• Participate in training and developing new staff, providing guidance as needed.
• Assist supervisors and managers with internal and external audits.
• Contribute to developing insurance guidelines, frameworks, and processes within MH.
• Analyze claim adjustments, bad debt provisions, and contractual allowances.
• Perform accuracy checks for all claim submissions and resubmissions as per agreed contracts.
• Coordinate discussions between billing clerks and utilization nurses for insurance claims process.
• Manage a collection desk for outstanding balances in the revenue cycle process.
• Develop claim reports for analysis and performance measurement.

Qualifications

• Bachelor’s Degree in Finance, Accounting, Business Administration or related fields
• 4-5 years of career experience
• Experience within Finance/ Accounting/Insurance environment in a healthcare facility
• Familiar with UAE Insurance practices

• Ensure high accuracy in claims processes for insurance and corporate review, adhering to contractual agreements for efficient reimbursement.
• Coordinate with insurance companies for eligibility verification, payment approvals, and reconciliation.
• Provide customer service support for insurance verification, eligibility, and preauthorization.
• Accurately liaise with staff to ensure timely entry of insurance information and benefits.
• Verify claims compliance with billing guidelines.
• Coordinate with doctors and senior officers to provide updates and training on insurance and billing guidelines.
• Communicate insurance guidelines and procedures to front-line staff.
• Support other departments and payers in tracking payments.
• Monitor receivables and conduct financial reconciliation for remittance advice.
• Maintain proper records and files for claims correspondence with insurance and private or corporate businesses.
• Participate in training and developing new staff, providing guidance as needed.
• Assist supervisors and managers with internal and external audits.
• Contribute to developing insurance guidelines, frameworks, and processes within MH.
• Analyze claim adjustments, bad debt provisions, and contractual allowances.
• Perform accuracy checks for all claim submissions and resubmissions as per agreed contracts.
• Coordinate discussions between billing clerks and utilization nurses for insurance claims process.
• Manage a collection desk for outstanding balances in the revenue cycle process.
• Develop claim reports for analysis and performance measurement.

• Bachelor’s Degree in Finance, Accounting, Business Administration or related fields
• 4-5 years of career experience
• Experience within Finance/ Accounting/Insurance environment in a healthcare facility
• Familiar with UAE Insurance practices