Team Lead - Resubmission & Reconciliation

About the role

The Team Lead – Resubmission & Reconciliation will oversee the timely resubmission of denied claims and ensure accurate reconciliation with insurance companies and TPAs. The role focuses on reducing financial risk, improving claim quality, and coordinating with multiple internal stakeholders.

Key responsibilities

• Manage and accelerate the early closure of quarterly, semi‑annual and annual reconciliations.
• Interact with physicians to obtain clinical justification for rejected claims.
• Collaborate with the Insurance Approvals and Claims Submission teams to minimise denials.
• Ensure compliance with DHA and insurance industry regulations for claim resubmissions.
• Monitor and achieve daily resubmission TAT targets while maintaining quality.
• Analyse root causes of denials, create system rules to prevent recurrence, and provide feedback to billing teams.
• Coordinate with Clinical Documentation and other clinical teams to improve documentation quality.
• Highlight payment discrepancies to the Head of Department and work on corrective strategies.

Required profile

• Proven experience in medical claims resubmission and reconciliation.
• Strong knowledge of UAE insurance regulations and DHA guidelines.
• Leadership ability to guide a team and meet KPI targets.
• Analytical mindset to identify denial patterns and drive process improvements.

Required skills