Senior Outpatient Claims Adjuster

About the role

We are seeking a Senior Outpatient Claims Adjuster to lead the review and adjustment of outpatient claims within our Cairo office. The role involves ensuring accurate processing, compliance with provider guidelines, and supporting the audit team.

Key responsibilities

• Review, revise and oversee the workflow together with the audit team.
• Validate and review processed outpatient claims on the I*Geme system.
• Provide support to claims processors to facilitate claim processing.
• Report adjustment reasons and perform additional adjustments on I*Geme.
• Validate and classify claims and deductions per provider.
• Ensure proper application of I*Care by providers and detect any misuse.
• Report missing services or items and tariff mismatches regularly.
• Run reconciliation reports to identify flagged discrepancies and correct them.
• Handle filing and sorting of deducted claim soft copies according to provider categories.
• Send adjusted claims to the designated shared folder and close claims in the system.
• Recommend new adjustment reasons for outpatient claims to be implemented in the system.

Required profile

• BS degree in Pharmaceutical Sciences from a reputable university.
• At least one year of experience in community or hospital pharmacies.
• One year of experience in the TPA industry or claims processing (preferred).
• Strong medical background and good to very good command of English.
• Proficiency in MS Office and overall computer literacy.
• Target‑oriented, team player with the ability to handle stress.
• Analytical and organizational skills with the capacity to manage multiple assignments.
• Effective verbal and non‑verbal communication skills.

Required skills

• MS Office
• I*Geme
• I*Care