Medical Claims Processor - Reimbursement - UAE

Location: Dubai
Company Name: AXA General Insurance

Medical Claims Processor - Reimbursement (19000CJB)

PRIMARY LOCATION : UNITED ARAB EMIRATES-UNITED ARAB EMIRATES-DUBAI

ORGANIZATION : AXA Gulf

CONTRACT TYPE : Regular

SHIFT : Day Job

SCHEDULE : Full-time

DESCRIPTION

Job Purpose:

• Adjudication and processing of reimbursement claims in accordance to policy terms and conditions in a timely manner, applying sound medical judgment based on best practice during assessment of claims.
• Identification of trends related to abuse and fraudulent claims.
• Interpret and process claims using knowledge of ICD codes, billing, benefits, and company policies.
• To respond to and liaise as required with AXA policy holders, insurance brokers and network providers in a professional and courteous manner.
  

Main Responsibilities:

You will:

• Process reimbursement claims following SOPs, applying sound medical judgment based on best practice and in accordance with the conditions & terms of the policies;
• Handle relationships with clients and brokers regarding reimbursement claims by asking for additional information whenever required, by explaining the details of the settlements (i.e. application of the deductible and coverage, justify rejections and uncovered expense);
• Process the claims within a reasonable time frame within SLA and meeting the set KPIs;
• Minimize conflicts with clients whilst applying strictly the policy conditions;
• Adjudicate and approve claims within the authority limits set and to refer cases to the claims manager for approval where authority limits are exceeded.

QUALIFICATIONS

Minimum Requirements:

• Sound knowledge of all medical insurance policies, billing policies and pricing / fee arrangements;
• Expert knowledge of medical conditions, treatments and procedures;
• Bachelor degree or Equivalent (Medical related degree- nursing, therapy, medical technology, pharmacy);
• At least 3 years experience on the same field;
• Certified Medical Coder

ABOUT AXA

Would you like to wake up every day driven and inspired by our noble mission and to work together as one global team to empower people to live a better life? Here at AXA we strive to lead the transformation of our industry. We are looking for talented individuals who come from varied backgrounds, think differently and want to be part of this exciting transformation by challenging the status quo so we can push AXA - a leading global brand and one of the most innovative companies in our industry - onto even greater things.

In a fast-evolving world and with a presence in 64 countries, our 166,000 employees and exclusive distributors anticipate change to offer services and solutions tailored to the current and future needs of our 103 million customers.

With a workforce of over 1,000 employees, 44 branches & retail shops region-wide, more than 1 million customers and 2015 gross written premium of over US$ 963 million, AXA is one of the largest international player in the GCC. Present in the region for more than 65 years, AXA in the Gulf offers a wide range of insurance products and services for corporate, SME and individual customers.

Our business is to protect people over the long term. We emphasis on designing reliable solutions to meet the needs of our customers, manage risks in a professional way, treat our partners fairly, develop a work environment built on strong values, relationship and trust

We also believe that we have a role to play in protecting the environment, supporting the communities in which we operate, and more broadly in helping to create stronger and more sustainable societies. This is part of creating a sustainable, long-term business, and becoming the preferred company for our customers, employees, and other stakeholders.

AXA Gulf has been awarded General Insurance Company of the Year for 2nd consecutive year and Health Insurance Company of the Year at the 2015 Middle East Insurance Industry Awards (MIIA), Insurer of the Year and Personal Lines insurer in 2016 at the MENA Insurance Awards and Best Motor Insurance Product by the Banker Middle East in both UAE & KSA.

As part of AXA’s corporate responsibility and its commitment to building better understanding about the health risks faced by individuals and the society, the company achieved a new Guinness world record for the most blood cholesterol readings in 8 hours at a single venue.

WHAT WE OFFER

We are investing significantly in the Gulf region and we recognise the important role employees have in the success of our business.

We offer excellent opportunities for motivated and talented candidates whether at entry level or at c-suite level.

We value diversity and we encourage applicants of various backgrounds and nationalities to join our team.