Resubmission & Reconciliation Officer

About the role

The Resubmission & Reconciliation Officer supports Al Futtaim Health by managing insurance claim denials, ensuring timely resubmissions, and coordinating with internal and external stakeholders to resolve issues. The role focuses on improving claim acceptance rates while complying with DHA and industry regulations.

Key responsibilities

• Update the Insurance Manager on unusual denials and coordinate resolution discussions.
• Perform first and second‑level resubmissions of IP, OP, and pharmacy claims with proper medical and technical justification.
• Communicate with payers for clarification and negotiate to reduce denials.
• Collaborate with physicians, CDI, and billing teams to obtain clinical justification and proper documentation.
• Analyze root causes of denials, create system rules to prevent recurrence, and maintain KPI records.
• Prepare detailed denial reports segmented by technical and medical reasons.
• Identify defaulting payors, provide financial analysis, and support corrective strategies.

Required profile

• Certified professional coding certificate from a reputable institution.
• Certified medical or paramedical qualification.
• Minimum 3 + years experience in claim resubmission, denial management, or similar role.
• Strong medical background and ability to work under pressure to meet targets.

Required skills

• Medical coding
• Insurance claim processing
• Denial management