Associate, Claims Operations

About the role

Reliance Health, a healthcare technology company operating across Nigeria, Egypt, Senegal and Cote d'Ivoire, is hiring an Associate, Claims Operations in Cairo. The role ensures healthcare claims are processed accurately and efficiently, maintains fairness in the system by validating claims and identifying inconsistencies, and supports timely reimbursements.

Key responsibilities

• Review, validate and process healthcare claims in line with company policies
• Ensure claims are accurately recorded and maintained in the system
• Investigate complex claims and make decisions based on clinical standards and internal guidelines
• Support timely payment of approved claims within defined service timelines
• Identify and decline fraudulent or suspicious claims, and investigate cases of fraud, waste and abuse, escalating findings where necessary
• Collaborate with provider management teams to resolve provider-related issues
• Share claims updates and reconciliation details with healthcare providers
• Provide clinical input on complex care approvals and support patient referral decisions with the care team

Required profile

• Bachelor's degree in Medicine (MBBS or equivalent)
• At least 1 year of clinical experience as a medical doctor
• Strong understanding of clinical procedures, terminology and standards of care
• Ability to apply clinical knowledge to claims review and decision-making
• Experience in claims processing or care approvals is a plus

Required skills

• Strong numerical and analytical skills
• Accurate handling of data and information
• Clear written and verbal communication
• Proficiency in Microsoft Word and PowerPoint

What we offer

• Salary of EGP 16,518.19 per month
• Hybrid role based in Cairo
• Unlimited leave
• Premium health insurance for you and your family
• Learning and development allowance