Medical Claims Examiner (Daman)

Job Overview:
The National Health Insurance Company (Daman) is actively seeking highly analytical Medical Claims Examiners to join our Abu Dhabi headquarters. You will be responsible for scrutinizing complex medical invoices, enforcing strict DoH regulations, and ensuring the absolute financial accuracy of healthcare payouts across our massive provider network.

What You Actually Need (Requirements):

  • Bachelor’s Degree in Nursing, Medicine, Pharmacy, or related clinical fields.
  • Active, internationally recognized medical coding certification (AAPC, AHIMA, CPC).
  • 2-5 years of direct experience in UAE health insurance or hospital billing.
  • Deep understanding of CPT, ICD-10 coding, and DoH adjudication guidelines.
  • Exceptional analytical skills to detect billing anomalies, upcoding, and unbundling.

Your Daily Reality (Responsibilities):
  • Adjudicating high volumes of inpatient and outpatient medical claims against active policy limits.
  • Identifying systemic billing errors or potential fraudulent activities from healthcare providers.
  • Liaising with hospital administrative teams to resolve complex claim disputes and missing documentation.
  • Maintaining strict adherence to processing turnaround times (TAT) and quality assurance metrics.
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