Job Description

We are seeking a senior, results-driven Insurance Claims & Revenue Cycle Manager with deep expertise in Daman insurance, Abu Dhabi claim workflows, and end-to-end revenue cycle control.

This role carries full accountability for reducing insurance rejections, accelerating collections, and ensuring timely reconciliation of all insurance receivables in compliance with DOH regulations.

Key Responsibilities:

1. Insurance Claims Rejection Reduction:

Lead and control the entire insurance claims lifecycle (pre-authorization, submission, resubmission, appeal). Reduce initial insurance claim rejections to ? 3% of total claims within 45 days. Actively manage and correct rejection causes related to: Physicians (clinical documentation & coding alignment) Medical coders (CPT / ICD / DRG accuracy) Reception & front desk errors (eligibility, approvals, data capture) Implement preventive rejection controls (pre-billing audits, checklist enforcement).

2. Daman-Focused Claims Management:

Handle Daman Enhanced, Basic, and Thiqa and other insurances workflows with full mastery. Maintain up-to-date knowledge of Daman/insurance companies policies, circulars, rules, and exclusions in the Emirate of Abu Dhabi. Ensure accurate compliance with clinical pathways, tariff rules, and submission timelines.

3. Insurance Reconciliation & Collections:

Achieve full reconciliation of all insurance claims within 90 days of submission. Track outstanding receivables, mismatches, underpayments, and denials. Ensure accurate follow-ups, resubmissions, and justifications until closure. Maintain a clean aging report with clear accountability and resolution tracking.

4. Revenue Cycle Control & Reporting:

Own insurance KPIs including: Rejection ratio Collection turnaround time Claims aging (30 / 60 / 90+) Recovery percentage Produce Daily, weekly and monthly performance reports for management. Identify revenue leakage and implement corrective actions immediately.

5. Cross-Department Leadership:

Work closely with: Doctors (clinical documentation quality) Medical coders Reception and front office teams Finance and operations Train and enforce best practices across departments to maintain rejection thresholds. Act as the final authority on insurance disputes and escalation matters.

Key Performance Indicators (KPIs):

The following KPIs are tied directly to compensation growth:

Insurance Reconciliation KPI 100% reconciliation of insurance claims within 90 days of submission. Claims Rejection KPI Reduce and maintain initial rejection rate at or below 3% of total claims within 45 days, including: Doctor-related rejections Coder-related rejections Reception/front desk rejections

Mandatory Qualifications:

Minimum

10 years of insurance claims experience in Abu Dhabi

Strong, hands-on experience with Insurance claims Deep understanding of: DOH regulations ICD-10, CPT, DRG coding workflows Proven track record of reducing rejection ratios and accelerating collections

This Role Is Not Suitable For:

Junior or mid-level insurance staff Candidates without Abu Dhabi insurance experience
Job Type: Full-time

Pay: AED7,000.00 - AED8,000.00 per month