Medical Claims Review Officer
Saudi Arabian Cooperative Insurance Company (SAICO)
Riyadh, Riyadh Province, Saudi Arabia · Full Time
1 applicant
- Experience
- 2–3 yrs
- Salary
- —
- Openings
- 1
- Posted
- 4 weeks ago
- Work mode
- In office
- Education
- MBBS
- Eligibility
- Candidates with an MBBS degree, SCFHS licensure, and 2 to 3 years of relevant post-graduation experience in medical claims review, clinical assessment, or healthcare-related work may apply.
- Resume
- Required to apply
Where you'll work
Job description
Role overview
SAICO is hiring a Medical Claims Review Officer in Riyadh to assess and validate medical claims with a focus on clinical correctness, policy coverage, and adherence to medical guidelines. The role involves reviewing healthcare documentation, supporting proper claim adjudication, and handling provider discussions when claims are disputed.
Key responsibilities
- Check medical claims carefully to confirm they are clinically sound and aligned with policy terms and medical standards.
- Examine patient files, medical reports, and other supporting papers to support correct claim decisions.
- Explain claim rejections to healthcare providers using recognized Saudi and international medical guidelines.
- Handle disagreements on claims directly with medical service providers when needed.
- Work with internal teams to confirm claim values, claim status, and other related details.
- Contribute to fast, accurate, and policy-compliant claims handling through prompt decisions and clear communication.
- Meet assigned key performance indicators.
- Take part in learning and development activities and complete at least 25 training hours to keep clinical, operational, and insurance knowledge current.
- Support company projects as needed.
Required profile
Applicants should hold an MBBS degree and be licensed by the Saudi Commission for Health Specialties (SCFHS). The role calls for 2 to 3 years of post-graduation experience in medical claims review, clinical evaluation, or another healthcare-related function. Candidates should also be familiar with insurance claim workflows and healthcare regulations.
Skills and competencies
- Strong medical knowledge
- Clear written and verbal communication
- High attention to detail
- Customer-focused mindset
- Ethical and compliance awareness
- Ability to manage time and prioritize cases
- Medical claims review
- Clinical assessment
- Insurance process understanding
- Healthcare regulations knowledge
- Provider communication
- Dispute resolution
Additional information
This is a full-time, on-site position based in Riyadh, Saudi Arabia. No stipend or salary amount was specified in the source. The role includes participation in learning and development initiatives and company projects.