Reconciliation Officer

About the Role

We are looking for an Associate, Reconciliation to handle rejected and underpaid healthcare claims, investigate the reasons for rejection, and process/resubmit claims accurately to maximize revenue recovery.

Key Responsibilities

• Review and process rejected and underpaid healthcare claims
• Investigate claim rejections and identify the root cause
• Prepare and process resubmissions and appeals within defined timelines
• Ensure claims comply with coding and insurance guidelines
• Review claims from both medical and insurance perspectives
• Identify payment discrepancies and revenue leakage
• Reconcile claims against remittances and processed entries
• Maintain daily production and quality targets
• Identify and report recurring rejection and payment trends
• Provide feedback to Team Leaders on rejection trends and process issues
• Ensure timely follow-up and resolution of outstanding claims
• Report any claim-related issues or observations that may impact the process
• Coordinate with internal and external teams to resolve claim issues
• Maintain proper documentation and professional communication
• Ensure compliance with UAE healthcare regulations, payer guidelines and internal SOPs

Requirements

• 3-5 years of experience in Medical Claims Processing in a UAE provider, payer or TPA environment
• Minimum 2 years of experience in Reconciliation / Resubmission
• Bachelors Degree in Medicine (MBBS) or any medical-related field
• Good knowledge of UAE insurance protocols
• Strong knowledge of HAAD, Riayati and DHA guidelines
• Knowledge of ICD and CPT is preferred
• Strong MS Excel and MS Office skills
• Good analytical and problem-solving abilities
• Ability to handle complex claims and identify appropriate resolutions
• Strong attention to detail and accuracy
• Good communication and coordination skills
• Ability to work independently and meet daily targets