fatma Saad marmar

Senior Claims Medical AuditorFull Time

Senior Claims Medical AuditorFull Time

• Job Details:worked on the Comprehensive Health Insurance Authority project (UHIA). • Ensure that the patient is eligible to use comprehensive health insurance. • Performing technical audit on medical claims. • Justifying the rejection reasons on system in rejection cases to facilitate the reconciliation process. • Proper implementation of agreements on claims in collaboration with the audit and processing team. • Ensure that the patient deserves the required services and that they are correct and clear according to the medical history. • Coordination with other adjusters for distribution of the claims. • Review the required doses with the number of days of the patient’s stay. • Escalation of any problematic area to Supervisor. • Provide the Claim with the appropriate medical code for the medical condition

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