Job Description

Key Responsibilities

1. Insurance Operations Management

• Manage end-to-end insurance processes including eligibility checks, prior authorizations, claims submissions, and reconciliations.
• Ensure timely and accurate submission of insurance claims via DHA/DOH/MOHAP e-claim systems.
• Minimize claim rejections and denials by monitoring accuracy and compliance.

2. Contracting & Provider Network Relations

• Negotiate and manage contracts with insurance companies and TPAs.
• Maintain relationships with key insurance providers to secure favorable terms and ensure smooth operations.
• Monitor contract renewals, tariff agreements, and payment schedules.

3. Compliance & Regulatory Alignment

• Ensure compliance with UAE health authorities’ rules (DHA, DOH, MOHAP) and insurance regulatory frameworks.
• Implement policies for coding standards (ICD-10, CPT, DRG where applicable).
• Maintain confidentiality and ethical standards in handling patient insurance data.

4. Revenue Cycle & Reporting

• Monitor accounts receivable and insurance payment cycles.
• Conduct regular audits of insurance claims and denials.
• Generate management reports on claim performance, outstanding payments, and insurance KPIs.

5. Team Leadership & Training

• Supervise insurance coordinators/billing staff.
• Conduct training sessions on coding, claim submissions, and new insurance policies.
• Foster a culture of accuracy and accountability in insurance-related workflows.

Qualifications & Requirements

Education:

• Bachelor’s degree in Healthcare Management, Business Administration, Finance, or related field (mandatory).
• Certification in Medical Coding (CPC, ICD-10, CPT, or equivalent) preferred.
• Master’s degree (MBA, Healthcare Management) is an added advantage.

Experience:

• 5–7 years of experience in medical billing/insurance in the UAE healthcare sector.
• At least 2–3 years in a managerial or supervisory role within a medical centre, hospital, or TPA.
• Strong background in UAE insurance systems (eClaimLink, DHPO, Shafafiya for Abu Dhabi, etc.).

Skills:

• In-depth knowledge of UAE healthcare insurance regulations and claim processes.
• Strong negotiation and contract management skills.
• Excellent leadership, communication, and interpersonal skills.

Proficiency in medical coding systems (ICD-10, CPT).

• Strong analytical and problem-solving ability with a focus on reducing claim denials.
• Advanced MS Excel and ERP/EMR system knowledge (e.g., Cerner, Epic, or local systems integrated with DHA/DOH portals).