Health Insurance Operations Officer

Overview

Job Summary (Role Purpose):

PHCC has a vision to be the leader in transforming the health and wellbeing of people’s lives in Qatar. PHCC’s mission is to deliver comprehensive, integrated and coordinated person-centered health care services in the community through focusing on disease prevention, healthy lifestyles and wellness. In partnership with our stakeholders, we will improve the health and wellbeing of our population.

The incumbent will contribute to the organization by supporting the efficient implementation and daily execution of health insurance processes across assigned PHCC Health Centers.

• Support the implementation timeline, coordinate stakeholders, manage risks and deliverables and oversee day-to-day execution of insurance processes across all health centers
• Coordinate Training & Capacity Building for clinical and non-clinical staff on insurance processes, and documentation requirements.
• Coordinate the insurance related process between all directorates / depts within Operations.
• Serve as the primary operational support contact for Health Center Leads on all insurance workflow matters.
• Facilitate communication of policy updates, process changes, and workflow clarifications.
• Escalate center-specific operational issues, data discrepancies, and recurring patterns affecting claim acceptance.
• Assist health center staff in escalating real-time operational bottlenecks such as missing documentation, rejected pre-authorization requests, or eligibility conflicts.
• Serve as the point of contact with Billing & Insurance staff to ensure accurate documentation is captured before claim submission.
• Assist in implementing documentation improvement plans recommended by HIM or Coding Specialists.
• Ensure accurate and timely correction of errors before claim submission and resubmission stages.
• Support orientation of new staff assigned to insurance-related duties at the Health Center.
• Demonstrate proactive approach to patient safety by thinking what might go wrong in all undertakings and take necessary measures to prevent them from happening.
• Identify and report potential or actual patient safety concerns, errors and/or near misses in timely manner.
• Partner with line manager to understand risks in the area of work, develop a plan on how to mitigate those risks,
• Ensure high standards of confidentiality to safeguard any sensitive information.
• The incumbent will undertake any such related duties or responsibilities as directed.

bachelor’s degree in Healthcare Administration, Business Administration, Health Information Management, or related field.

Minimum 2 years of experience in health insurance operations, patient access, billing, claim workflows, or healthcare administration