Resubmission & Reconciliation Officer

Al Futtaim Group
Dubai
Workplace: OnsiteFull timeFunction: Healthcare (Clinical, Medical, Wellness)Experience: 3+ yearsEducation: certificationSkills: ["Negotiation","Presentation","Analytical skills","Decision-making","Ability to work under pressure"]

Own the resubmission and reconciliation process for eligible IP, OP, and Pharmacy claims. Follow up on unusual denial issues with insurance companies, communicate with payers at 1st and 2nd resubmission stages, and gather clinical justification from physicians. Ensure claims are processed per insurance industry practices and DHA regulations, track KPIs and monthly denial data, and analyze denial root causes to prevent recurrence.

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FursaFursa
Al Futtaim Group
Al Futtaim Group
1 day ago

Resubmission & Reconciliation Officer

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Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI
Last checked: 7 hours agoStatus: Live

Job Summary

Own the resubmission and reconciliation process for eligible IP, OP, and Pharmacy claims. Follow up on unusual denial issues with insurance companies, communicate with payers at 1st and 2nd resubmission stages, and gather clinical justification from physicians. Ensure claims are processed per insurance industry practices and DHA regulations, track KPIs and monthly denial data, and analyze denial root causes to prevent recurrence.
Location: Dubai
Workplace: Onsite
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Mid level

Key Responsibilities

  • •Update the insurance manager about unusual denial/issues for discussion and resolution.
  • •Ensure timely resubmissions of eligible IP, OP, and Pharmacy claims with appropriate medical and technical justification.
  • •Communicate with payers to clarify rejected claims at 1st resubmission and 2nd resubmission-reconciliation stages.
  • •Interact with physicians to obtain clinical justification for rejected claims.
  • •Maintain resubmission KPI records, monthly reconciliation/denial data, and analyze root causes to prevent recurring denials.

Key Requirements

  • •Certified professional coding certificate from a reputed institution
  • •Certified medical/paramedical certificate
  • •3+ years’ experience in a similar role
  • •Strong negotiation skills
  • •Strong medical background to handle reconciliation efficiently
Experience:3+ years
Education:Certification / Diploma
Skills:NegotiationPresentationAnalytical skillsDecision-makingAbility to work under pressure
Certifications:Certified professional codingCertified medical/paramedical

Company Brief

Al Futtaim Group
Al-Futtaim Group is a diversified UAE conglomerate operating across automotive, retail, real estate, finance and services, representing 200+ global brands and serving customers across 20+ countries with over 40,000 employees.
Industry: Conglomerates & Holding Companies
Company Size: Enterprise (1,001+ employees)
Growth: Established Company
Funding: Bootstrapped
Headquarters: Dubai, United Arab Emirates
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