Senior Manager - Insurance Business Rules / RCM / Denial Management

Senior Manager - Insurance Business Rules / RCM / Denial Management Role Summary : Business Rules Senior Manager

Responsible for managing the product image and its development through client interface by connecting Content and Business teams (BDU) simultaneously.

Ensuring and supporting the development of rules content by providing support to internal teams through review, guidance, and validation of activities.

Reviewing data analytics and extracting insights based on market payers, regulator protocols, claims denial trends, and user feedback analysis.

Working closely with stakeholders like payers, regulators, healthcare providers, and revenue cycle departments to ensure adherence to market billing standards and protocols, analyzing coding / billing issues for compliance with policies, and addressing payer denials in the KSA market.

Primary Responsibilities

Act as a bridge between internal THYNK team and management to communicate the product vision and development.

Partner with clients to incorporate their feedback and updates into the product.

Coordinate with teams regularly to support the product's vision.

Develop functionalities aligned with market practices to enhance the product.

Work effectively under pressure and manage multiple reporting lines.

Validate claim remittance reports monthly, review denial trends, and provide feedback to improve the rule engine, reducing denials and maximizing remittance.

Analyze bypass reports and end-user feedback to improve rules logic, quality, and validation outcomes.

Review clients' historical denial reports to identify trends and develop rules to improve revenue integrity.

Communicate effectively with internal and external parties, analyzing market insights and best practices to define rules content.

Job Requirements

Minimum 10 years of experience in claim adjudication lifecycle with payers / TPAs.

Experience with Data Analytics tools like Power BI is preferred.

Strong analytical skills and attention to detail.

Understanding of insurance adjudication guidelines and protocols, especially in the KSA market.

Professional certification in Medical Coding is a plus but not mandatory.

Knowledge of local regulations and adjudication protocols in KSA.

Excellent communication and presentation skills.

Proficiency in Healthcare Information Systems.

Medical background (Doctor, Nurse, Pharmacist) is highly desirable.

Certifications in Insurance and Project Management are highly valued.

Additional Information

Seniority level : Mid-Senior level

Employment type : Full-time

Job function : Finance and Sales

Industries : IT Services and IT Consulting

This job posting is active and accepting applications.

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