Job Description

The Claims Submission & Resubmission Officer is responsible for preparing, submitting, and monitoring medical claims to insurance companies to ensure accurate and timely reimbursement for hospital services.

Managerial

• Coordinate with relevant teams to ensure smooth insurance claims processing and workflow efficiency
• Support communication between billing, coding, and insurance departments

Technical

• Prepare and submit insurance claims for hospital services, ensuring accuracy in coding and patient information
• Verify patient insurance eligibility and coverage prior to claim submission
• Collaborate with billing and coding teams to ensure claims meet payer requirements
• Monitor claim submission status and follow up on pending or unprocessed claims
• Respond to insurance provider queries related to claim details
• Maintain accurate records of submitted claims and their status updates
• Stay updated with insurance policies, regulations, and claim submission protocols

Quality and Safety

• Promote and maintain quality standards and support continuous quality improvement initiatives
• Comply with safety, infection control, and quality control policies and procedures
• Ensure adherence to environmental safety and infection prevention practices
• Support clinical audit processes and reporting requirements
• Communicate professionally with patients, families, and healthcare staff to obtain or clarify required information
• Ensure documentation accuracy and compliance with hospital standards

Continuous Education

• Participate in training sessions for staff, doctors, and nurses on equipment handling and related processes
• Attend departmental programs, hospital committees, and staff meetings when required
• Support orientation and training of new employees
• Maintain professional knowledge through lectures, seminars, and online learning
• Complete all required licensing, certification, and mandatory training within deadlines
• Apply knowledge of relevant sciences such as anatomy, physiology, and related technical fields

Occupational Safety and Health (OSH)

• Comply with all OSH and infection control policies, standards, and procedures
• Report OSH hazards, incidents, near misses, and assist in risk assessments
• Participate in OSH and infection control training, drills, and awareness programs
• Follow safe working procedures and use appropriate personal protective equipment (PPE)
• Adhere to emergency and evacuation procedures
• Ensure proper waste management practices (reduce, reuse, recycle)
• Participate in OSH audits and inspections to maintain standards

Prevention and Control of Infection (PCI)

• Adhere to NMC PCI Policy and Strategy at all times
• Maintain strict hand hygiene practices, including the 5 moments of hand hygiene

• Follow “bare below the elbows” and environmental cleanliness standards

Qualifications & Licensure

• Bachelor’s degree in Healthcare Administration, Nursing, Paramedical, or a related field
• Knowledge of medical coding, billing processes, and insurance claim management
• Proficiency in hospital management systems and claims submission software
• Strong organizational skills with excellent attention to detail
• Excellent communication and problem-solving abilities

Experience

• Relevant experience in healthcare administration, insurance claims, billing, or related functions (as applicable to role requirements)

Specialist Certification

• Required: NA
• Desired: NA

Additional Requirements

• Self-motivated and able to work under pressure
• Fluent spoken and written English (Arabic is advantageous but not mandatory)
• Supportive, caring, and professional disposition
• Strong adaptability and time management skills
• Confidence in handling stressful situations
• Strong IT competencies and computer literacy