Medical Claims Auditor - Insurance - Abu Dhabi

Position: Medical Claims Auditor

Experience: Experienced in Medical Claims Auditor in the insurance or TPA.

Responsibilities:

1. Coordinate with the providers or payers in case of mismatch between the provided statement of account and actual invoice submission.
2. Conduct external audits of providers, focusing on Medical Documentation and Billing.
3. Update the external audit report to management.
4. Audit In-patient and Out-patient reimbursement claims.
5. Maintain internal audit reports of claim processing.
6. Handle and respond to queries from the Claims Team on Medical Coding (DRG, unbundling code, up coding, medically justify).
7. Interact with other teams (Claim Centre, Network Team, and IT) on Medical coding.
8. Visit providers to check further records, detect fraud cases, and report to the concerned departments for action.

Job Types:

Full-time, Permanent

Pay:

AED7,000.00 - AED9,000.00 per month

Ability to commute/relocate:

• Abu Dhabi: Reliably commute or planning to relocate before starting work (Required)