MEDICAL CLAIMS ANALYST.
Job Title
MEDICAL CLAIMS ANALYST
Job Family
Function
Corporate
Job Code
30009906
Reports to Job
Unit Manager
Job Description Summary
Independent contributor role focused on specialized claims adjudication and pattern recognition. Responsible for handling trend-based claims while identifying process improvements and serving as a resource for junior staff.
Strategic Roles & Responsibilities %
5%
Strategic Roles & Responsibilities
- Identify emerging claim patterns and propose minor process improvements
- Contribute to workflow optimization through trend analysis
Operational Roles & Responsibilities %
95%
Operational Roles & Responsibilities
- Independently review specialized and trend-based medical/dental claims
- Apply clinical and policy knowledge to complex scenarios
- Identify patterns in claim data and propose process improvements
- Conduct self-audits on 10% of own work for accuracy against clinical guidelines
- Draft initial responses to provider disputes for supervisor review
- Serve as resource for Level 1 staff on common claim scenarios
- Maintain expertise in current policy and clinical guidelines
Minimum Education Required
Bachelor degree in healthcare administration, business, or related field preferred
Professional Certifications Required
-
Years of Experience
2-4 years of claims processing experience in healthcare or insurance
Languages
Arabic : Advanced
English : Advanced
Functional Competencies
- Accounts Receivable
- Billing Investigations
- Billing Statement Preparation
Core Competencies
- Excellence
- Integrity
- Accountability
- Cybersecurity
- Person-Centered Care
Acknowledgement
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Addendum Title
Supplemental Work/Experience/Education Information
Addendum Description