Claims Officer

The Claims Officer job at Cigna Healthcare in Oman centers on assessing medical reimbursement and provider claims against policy terms and clinical paperwork. It sits within Cigna Middle East Claims Operations and welcomes healthcare-qualified candidates who are just starting out, as well as those with one to two years in claims or health insurance.

About the claims officer job in Oman

The work draws on clinical knowledge. The officer reads medical information next to the member’s policy benefits and the supporting documents, so that each claim is assessed fairly, consistently and accurately. The listing describes it as a fit for an analytical, detail-oriented professional who wants a career in health insurance and claims operations.

Responsibilities

• Assesses member reimbursement and provider claims within the agreed quality, productivity and turnaround-time standards
• Reviews claim forms, medical reports, prescriptions, invoices, receipts, investigation results and proof of payment
• Validates eligibility, coverage, service dates, diagnoses, procedures, coding, billed amounts and provider details against the clinical evidence
• Applies policy terms, benefits, limits, exclusions, clinical guidelines and pricing rules, along with deductibles, co-insurance and member-share requirements
• Tests medical necessity: the diagnosis, documentation and treatment have to support the services claimed
• Flags incomplete documentation, duplicate or inconsistent billing, coding concerns, non-covered services and unusual billing patterns
• Keeps auditable notes for every decision, requests missing information, and escalates complex, high-value, disputed or medically unclear cases
• Explains claim decisions and documentation requirements to internal stakeholders while following Cigna’s privacy, regulatory and information-security controls

Requirements

• Qualification in a clinical or allied-health field, including BAMS, BHMS or an equivalent medical degree
• Sound knowledge of medical terminology, diagnoses, procedures, treatment pathways and clinical documentation
• Basic grasp of ICD and CPT coding and of insurance benefits, exclusions, deductibles and co-insurance, with willingness to deepen it
• Strong written and spoken English
• Analytical and numerical skills with close attention to detail
• Ability to prioritize, meet deadlines and handle confidential information appropriately
• Ability to interpret medical records and claim documents, adapt to claims-processing systems and work in Microsoft Office
• A collaborative approach across teams and willingness to learn in a health insurance setting

Preferred qualifications

• One to two years in medical claims, preauthorization, medical billing, provider operations or health insurance
• Experience with reimbursement or provider claims, including international or Middle East medical claims
• Previous exposure to healthcare or health insurance operations

Benefits

• A salary the listing describes as competitive
• Multicultural, hybrid working environment
• Private medical insurance
• Employee wellbeing benefits
• Educational development program

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, describes itself as a global health service company with roots in the U.S., operations in over 30 countries, and more than 180 million customers and patients.

How to apply

Candidates apply using the button below through Cigna’s online application process.