Medical Rules - Senior Manager; KSA

Medical Rules - Senior Manager (KSA)

Role

Summary:

Responsible for managing product image and its development through client interface by connecting Content and Business teams (BDU) simultaneously.

• Act as bridge between THYNK product team and management to communicate vision and product development.
• Partner with clients to bring vision updates to product team.
• Liaise regularly with team and review activities to support management vision.
• Develop functionalities that best support product in line with market practice.
• Work effectively under pressure and report to multiple lines of management.
• Monthly validate with analysis team, review claim remittance reports for all payers, and provide feedback to rule engine to reduce denial trends and maximize remittance output.
• Regularly analyze and review bypass reports with end‑user feedback to improve rules logic, quality, accuracy, and user experience.
• Review historical denial reports with internal teams, establish trend analysis and target rules content to address revenue integrity.
• Communicate with all parties internally and externally, analyze market insights and best practices, and provide accurate representation of issues and proposed solutions in Rules Content definitions.

• Minimum 10 years experience in claim adjudication lifecycle and Insurance Payer or TPA.
• Experience with Data Analytics packages such as Power BI (preferred).
• Excellent analytical skills and eye for detail.
• Understanding of insurance adjudication guidelines and protocols to enrich KSA Medical Rules repository.
• Professional Certification in Medical Coding (plus but not mandatory).
• Well versed in KSA local market regulations and claims adjudication protocols.
• Excellent verbal/written communication and presentation skills.
• Proficiency in Healthcare Information Systems.
• Medical training as Doctor/Nurse/Pharmacist highly desirable.
• Certifications in Insurance and project management highly desirable.

Mid‑Senior level

Full‑time

Health Care Provider

IT Services and IT Consulting