should handle the insurance team independently
submit documents for Claims and follow it up until approved
Job Title: Head – Insurance Approvals, Submission, and Claims
Location: Oman
Job Summary:
The Head of Insurance Approvals, Submission, and Claims is responsible for overseeing and managing all insurance-related activities within the hospital. This includes the timely processing of insurance approvals, accurate submission of insurance claims, and effective follow-up to ensure maximum reimbursements. The role requires close coordination with clinical, billing, and insurance teams to optimize revenue cycle efficiency while ensuring compliance with payer policies and regulatory guidelines.
Key Responsibilities:
1. Insurance Approvals & Pre-authorizations:
• Supervise and manage the team responsible for obtaining timely pre-approvals from insurance providers.
• Ensure complete and accurate documentation is submitted for pre-authorization requests.
• Liaise with physicians, consultants, and diagnostic departments for required inputs.
• Monitor turnaround time (TAT) for approval processes and address any delays.
2. Insurance Claims Submission:
• Oversee the preparation and electronic/manual submission of insurance claims.
• Ensure accuracy of coding (ICD-10, CPT, DRG), billing formats, and supporting documents.
• Conduct periodic audits of submitted claims to reduce rejections and denials.
• Coordinate with the billing and IT departments to ensure claims are integrated with HIS/ERP systems.
3. Claims Management & Reconciliation:
• Manage end-to-end claims cycle from submission to final payment.
• Track pending and rejected claims; analyze reasons and drive resolution.
• Coordinate with insurance companies for claim status updates, escalations, and disputes.
• Ensure timely reconciliation of insurance receivables with finance/accounts team.
4. Relationship Management:
• Develop and maintain strong working relationships with insurance companies and TPAs.
• Participate in regular meetings with payers to review performance, address concerns, and negotiate terms where needed.
5. Compliance & Policy Adherence:
• Ensure all processes are in compliance with healthcare regulations, insurance guidelines, and hospital policies.
• Maintain confidentiality and security of patient data and insurance information.
6. Team Leadership & Development:
• Lead and mentor a team of insurance executives, coders, and billing specialists.
• Conduct training sessions for staff on updates in insurance policies, coding standards, and claim handling procedures.
• Monitor team performance and implement KPIs to improve efficiency.
Qualifications:
• Bachelor’s degree in healthcare administration, Business Management, Finance, or related field.
• Preferred: Master’s Degree (MBA / MHA), or certifications in medical coding (CPC, CCS).
• Experience: Minimum 8–10 years of experience in hospital insurance operations, with at least 3–5 years in a leadership role.
• Strong knowledge of insurance practices in the GCC region, especially Oman.
• Familiarity with health insurance systems, TPAs, and international insurance protocols.
• Proficiency in HIS and insurance claim management software.
Key Skills:
• Deep understanding of medical insurance processes (approvals, coding, billing, reimbursements).
• Strong leadership, communication, and negotiation skills.
• Analytical and problem-solving capabilities.
• Detail-oriented with a high level of accuracy.
• Ability to manage multi-functional teams and handle high-pressure situations.