Medical Claims Coordinator

Medical Claims Coordinator (position is pending donor approval)

TEAM/PROJECT: Programme Operations, SDC Health Team

LOCATION: Aswan

GRADE : Grade 5

CONTRACT DURATION: Till December 2026 -

this is pending donor's approval

Child Safeguarding:

Level 3: the role holder will have contact with children and/or young people either frequently (e.g. once a week or more) or intensively (e.g. four days in one month or more or overnight) because they work in country programs; or are visiting country programs; or because they are responsible for implementing the police checking/vetting process staff.

ROLE PURPOSE:

The Medical Claims Coordinator is responsible for auditing and verifying all medical records and financial claims received from healthcare service providers. This includes reviewing supporting medical documentation, ensuring accuracy and compliance with SCI guidelines, maintaining strong relationships with suppliers, negotiating any discrepancies, and ensuring timely claim submissions.

SCOPE OF ROLE:

• Reports to : Health Officer

• Staff reporting to this post :NA

KEY AREAS OF ACCOUNTABILITY

• Validate medical information and claims received from healthcare service providers.

• Proofread and verify data for completeness and accuracy, identifying and correcting errors or omissions.

• Communicate with healthcare providers and SCI Medical Coordinators to verify and clarify information and documentation.

• Review medical records, patient histories, billing documents, and related files to determine coverage, payment amounts or overpayments, and patient conditions.

• Ensure medical bills comply with agreed contract price lists.

• Maintain effective professional communication with all healthcare providers and suppliers.

• Ensure full compliance with SCI finance and procurement policies, procedures, and guidelines.

• Accurately enter and manage data related to medical bills and claims.

• Prepare regular reports by collecting, analysing, and summarizing relevant information.

• Draft necessary correspondence, forms, invoices, and other required documents.

• Perform other related tasks as assigned by the line manager.

• Ensure the mainstreaming of SCI's Child Safeguarding Policy in all program activities.

• Provide technical support or training to field teams on proper documentation and claim submission procedures

• Participate in internal or external meetings related to health service provision, vendor management, or case review.

• Uphold and ensure adherence to SCI policies and procedures to maintain operational efficiency.

• Review and follow up on medical-related cases received from the Accountability/Aswan MEAl team, ensuring accurate verification, proper documentation, timely resolution, and feedback provision in line with SCI procedures.

SKILLS AND BEHAVIOURS (Our Values in Practice)

Accountability:

• Holds self-accountable for decisions, efficient resource management, achieving results, and role-modelling SCI values.

• Holds the team and partners accountable to deliver on responsibilities, providing freedom to deliver, supporting development, and applying appropriate consequences where needed.

Ambition:

• Sets ambitious, challenging goals for themselves and takes responsibility for personal development.

• Shares a clear vision for Save the Children, motivating and engaging others.

• Future-oriented, strategic thinker.

Collaboration:

• Builds and maintains effective relationships with team members, colleagues, partners, and external stakeholders.

• Values diversity as a source of strength.

• Approachable, a good listener, and easy to communicate with.

Creativity:

• Develops and promotes innovative solutions.

• Willing to take disciplined, calculated risks.

Integrity:

• Honest and committed to openness and transparency.

QUALIFICATIONS AND EXPERIENCE

• Bachelor's degree in medicine.

• Proven experience in reviewing and auditing medical claims is essential.

• 1–3 years of successful experience in projects with a reputable humanitarian NGO in Egypt, preferably in the health sector.

• Strong interpersonal and communication skills, including negotiation, influencing, and coaching abilities.

• Fluency in English and Arabic (spoken and written) required.

• Commitment to Save the Children's values and principles.