Officer Network Claims

For MedNet Global- UAE

As a member of Munich Re the MedNet Group is a leading Third-Party Administrator across the MEA region. We are currently seeking to hire a “Officer Network Claims” The job holder responsibilities are: Adjudicate, Process & Audit Network / Reimbursement outpatient & Inpatient claims.

Your Role:

• Manage daily claims administration work of review and processing of claims in line with scope of coverage and provider contracts.
• Audit claims data to identify any Fraud waste and abuse activities.
• Ensure accuracy and consistency of data.
• Forward approved claims once processed to PICs (Preferred Insurance Companies) for their acknowledgment or approval as per thresholds.
• Review and respond to claims audits of clients and internal audits.
• Answering provider, Insured members, and PICs queries accurately via phone calls and emails, regarding claims processing to provide clarifications where needed.
• Work with high efficiency, minimizing errors and administration time to achieve monthly deadlines and defined SOP's.
• Entering data accurately to provide accurate records to the company and PICs.
• Respond to external inquiries politely and professionally.

Your profile:

• Diploma In Nursing, Physiotherapy and Pharmaceutical Sciences.
• Coding certifications is an added advantage.
• Microsoft access database and power BI programming skills is an added advantage.
• 2-3 years of experience in claims in the insurance industry or TPA/MSO Company.
• Excellent interpersonal and communication skills with very good command of English.
• Working on split or straight shifts according to business needs.
• Ability to communicate sensitively and effectively with internal and external stake holders having regard for the strict need for confidentiality.
• Advanced knowledge of Microsoft packages (Word, PowerPoint, and Excel) e-mail, electronic calendar, and the Internet.

*Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunities employer.