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Insurance Navigation Fields Specialist

Insurance Navigation Fields Specialist

Manzil Healthcare Services - MHCSRiyadh, Riyadh Region, Saudi Arabia
7 منذ أيام
الوصف الوظيفي

The Insurance Navigation Fields Specialist plays a key role in assisting clients with navigating the complexities of their insurance policies, claims, and coverage options. This position requires a deep understanding of insurance products, as well as strong customer service and administrative skills. The specialist will act as an intermediary between the client and the insurance provider, ensuring that claims and coverage inquiries are handled efficiently and accurately.

Responsibilities

Claims Management

  • Handle rejected or denied claims by identifying errors, missing documentation, or eligibility issues; follow up with appeals or corrections as necessary.
  • Track and analyse patterns in claim denials to proactively reduce future issues.

Insurance Verification & Eligibility

  • Verify patient insurance coverage and eligibility.

    • Field Support & Hospital Visits

  • Visit hospitals, clinics, and healthcare facilities regularly to support HCPs with real-time insurance-related inquiries.

    • Reporting & Documentation

  • Maintain accurate and up-to-date records of patient interactions, insurance verifications, claim statuses, and authorizations.
  • Generate regular reports on claim submissions, approval rates, denials, pending actions, and appeals.
  • Communicate trends, delays, or systemic issues with leadership and collaborate on process improvements.

    • Stakeholder Collaboration

  • Liaise with insurance companies, third-party administrators (TPAs), and government health schemes to resolve issues and expedite processes.
  • Work closely with hospital case managers and medical teams to coordinate insurance-related workflows.

    • Compliance & Training

  • Ensure compliance with healthcare regulations, patient confidentiality (e.g., HIPAA), and institutional policies.
  • Educate hospital staff and patients on insurance processes and updates as needed.
  • Train other healthcare professionals / colleagues as needed.

    • Skills

  • Strong understanding of health insurance systems (private and public), claims lifecycle, and denial management.
  • Excellent interpersonal, communication, and negotiation skills.
  • Ability to handle sensitive patient information with professionalism and confidentiality.
  • Problem-solving mindset and ability to work independently in the field.
  • Ability to adapt to changing situations as needed.
  • Willingness to learn and improve continuously.
  • Maintain an optimistic and encouraging approach.

    • Other Requirements

  • Willingness to travel to multiple hospital sites or clinics as needed.
  • Possession of a valid driver’s license and reliable transportation (if applicable).
  • Fluency in Arabic and English.
  • Flexibility to take on additional responsibilities or tasks as assigned by the manager, based on the evolving needs of the team or organization.

    • Qualifications & Requirements

    Education

  • Bachelor’s degree in healthcare administration, Pharmacy, Public Health, Nursing, or related field (preferred).
  • Diploma / certification in Medical Billing, Insurance, or Patient Navigation (advantageous).

    • Experience

  • 2+ years of experience in health insurance coordination, medical billing, or healthcare navigation.
  • Experience working in a hospital, clinic, insurance company, or TPA setting is highly desirable.
  • Prior field experience or client-facing roles in healthcare preferred.

    • Interested applicants may send their updated CVs to with subject "Insurance Navigation Fields Specialist – KSA."

    Seniority level

  • Entry level

    • Employment type

  • Full-time

    • Industries

  • Health and Human Services

    • #J-18808-Ljbffr

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