Primary Responsibilities:

- Evaluates and ensures that all the medical & technical claims denied or underpaid inappropriately by payers are identified, appealed and reversed as per the set deadlines.
- Maintain production goals and quality standards set by the Team Leader. Team leaders will be conducting regular audits against the standard expected level of quality and quantity.
- Ensure all claims are in compliance with coding & insurance guideline
- Complete Knowledge of both HAAD, Riayati & DHA Guidelines.
- Maintaining and achieving the target deadlines.
- Provide daily feedback for rejection trends, and how to avoid it in the future in order to optimize clients revenue. This feedback should be given to the team leaders.
- Properly process and audit all type of claims received by the payers, from the medical and insurance perspective.
- Assure meeting the daily assigned target in terms of quantity & quality.
- Report back any type of claims observation or issues that may affect the process.
- Ensure that the medical ethics are respected at all times while performing the medical evaluation of the claims.
- Ensure that business decisions and processes are documented in a professional way and the communication requirements are being adhered to in a timely and professional manner.




- Confidant to accept valid rejections after completing the due diligence supported by documentation on acceptance reasons.
- To be able to coordinate with intradepartmental and extra-departmental colleagues in order to achieve the assigned task on time

Job Requirements:

- Bachelors Degree in Medicine (MBBS) or any Bachelor’s degree in the medical field.
- Any additional coding certifications (AAPC/AHIMA) related to the role will be an added advantage.
- At least 3-5 years’ medical claims processing experience with a provider / payer/ TPA in the UAE is essential.
- Should have at least 2-year experience in handling resubmissions/reconciliation.
- Valuable knowledge of insurance protocols.
- Should have good IT skills.
- Knowledge of ICD’s, CPT’s desirable
- Having good excel skills and other applications that is required for the role. Must have expert proficiency in MS Office.
- Ability to handle conflicts/problems and come out with proposal to resolve the conflict after sufficient analysis.
- Apply self-learning practice to assure consistency in the relevant functions required to meet our targets and keep our clients satisfied.

📌 Reconciliation Officer (Chennai)
🏢 ACCUMED
📍 Chennai