Job Title: Executive - Medical Claims Department: Medical Job Purpose To provide operational and administrative support for medical claims processing activities by ensuring accurate documentation handling, claim registration, verification, coordination with TPAs. The role ensures efficient claims workflow, proper maintenance of claims records and communication channels, and accurate claims data that supports monitoring of the medical loss ratio Duties & Responsibilities Ensure profitable management of the medical insurance portfolio Receive, register, and record medical claims and supporting documentation Verify completeness of claim submissions in accordance with required documentation standards Coordinate with policyholders, TPAs, and relevant stakeholders to obtain missing information Maintain organized claims records and documentation in accordance with company procedures Support verification of policy coverage, eligibility, and claim validity Assist in processing and tracking claims through various stages of approval and settlement Coordinate with TPAs regarding claim submissions, updates, and operational requirements Support preparation of reimbursement related documentation and processing activities Maintain claims databases and update system records accurately Respond to routine queries from policyholders regarding claim status and documentation Support investigation activities by collecting and organizing required claim information Escalate complex or disputed claims cases to relevant teams for review Assist in coordination of claim-related communication between internal and external stakeholders Support reporting requirements related to claims operations and processing activities Contribute to maintaining operational accuracy, efficiency, and service quality in claims administration Perform medical activities for Bank Muscat project, ensuring maximum conversion rates against agreed targets Coordinate the Bank Muscat project end to end, including outbound customer calls, follow-up, and closure of medical policies Process medical claims cases end to end, from registration through assessment, approval, and final settlement Provide timely support to customers and clients, resolving queries and complaints within the agreed TAT Perform finance reconciliation for medical claims, ensuring settlements, recoveries, and TPA balances are accurately matched and reported Process medical policy cancellations, including premium refund calculations and updating of system and policy records Evaluate motor claims cases involving medical injury and coordinate with the motor team on assessment and settlement of medical costs Undertake any other tasks delegated by the Head of Department, in line with the role and business requirements Qualifications & Experience Bachelor's Degree in Medical, Insurance, Finance, or related field Professional insurance qualification (CERT CII or equivalent) is an advantage Minimum 0–2 years of experience in insurance administration or medical claims support Basic understanding of medical insurance claims processes and documentation requirements Experience working with insurance systems and administrative workflows Good knowledge of customer service and data handling in insurance operations Competencies Medical claims documentation and registration knowledge Attention to detail and accuracy Coordination with TPAs and stakeholders Communication and customer service orientation Time management and organizational skills Teamwork and collaboration Data handling and record-keeping accuracy Compliance and process adherence
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