Senior Medical Claims Analyst.
Johns Hopkins Aramco HealthcareJob Title
SENIOR MEDICAL CLAIMS ANALYST.
Job Family
Function
Corporate
Job Code
30009907
Reports to Job
Unit Manager
Job Description Summary
Quality-focused role owning team-level accuracy and complex case resolution. Responsible for leading quality initiatives, resolving escalated disputes, and mentoring junior staff while contributing to policy refinement.
Strategic Roles & Responsibilities %
10%
Strategic Roles & Responsibilities
- Lead quality audit initiatives and implement corrective actions
- Contribute to policy refinement based on claim pattern analysis
- Mentor and develop junior staff capabilities
Operational Roles & Responsibilities %
90%
Operational Roles & Responsibilities
- Lead quality audits for the claims team, analyzing root causes of errors
- Implement corrective actions to reduce claim processing errors
- Resolve escalated provider disputes involving moderate-complexity clinical determinations
- Develop claim review checklists for high-frequency scenarios using trend data
- Update and refine policies based on claim pattern analysis
- Mentor junior staff on policy interpretation and dispute resolution
- Conduct training sessions on complex claim scenarios
- Maintain expertise in regulatory changes and industry best practices
Minimum Education Required
Bachelor degree in healthcare administration, business, or related field
Professional Certifications Required
Professional certification (e.g., CPC, CPB) preferred
Years of Experience
4-6 years of progressive claims processing experience in healthcare or insurance
Languages
Arabic : Advanced
English : Advanced
Functional Competencies
- Accounts Receivable
- Billing Investigations
- Billing Statement Preparation
Core Competencies
- Excellence
- Integrity
- Accountability
- Cybersecurity
- Person-Centered Care
Acknowledgement
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.