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Senior Medical Insurance Specialist - Makkah, Saudi Arabia

WHO THIS ROLE IS FOR:

Someone who understands that a denied claim usually started as a weak approval request. You've shortened approval turnaround times, cleared the "pending" queues that hold up admissions, and built pre-auth submissions strong enough that the claim behind them never gets questioned. And when a claim is denied anyway, you've written the appeal that overturned it. If you've managed volume for eight years but never moved a number, this isn't the right fit.

WHAT YOU'LL OWN:

Approvals / Pre-authorization

• Eligibility and coverage verification before service

• Preparing pre-authorization requests with clinical justification strong enough to be approved first time

• Following up on pending approvals and escalating delays that block admissions or scheduled procedures

• Handling urgent and emergency approvals within payer timeframes

• Owning first-time approval rate and approval turnaround time as your metrics

Claims / Denials

• Claim review, coding accuracy, and clean-claim submission

• Denial management -root-cause analysis, appeals, resubmission

• Reconciliation of outstanding balances with payers and TPAs

• Monthly reporting on rejection rate, approval turnaround, and days in AR

MINIMUM BAR:

• 8+ years covering BOTH approvals and claims in a hospital or polyclinic setting

• Demonstrated results - be ready to state your first-time approval rate and rejection rate, before and after

• Strong ICD-10 and CPT command; you identify a coding gap without waiting for a coder

• Deep familiarity with CCHI regulations, NPHIES, payer contracts, and medical necessity criteria

• Advanced Excel and hands-on HIS and payer-portal experience

• Professional Arabic and English - you'll write justifications and appeals in both

• PREFERRED: Coding certification (CPC / CCS), or prior experience on the payer side reviewing approvals.