Medical Rules - Senior Manager (KSA)

Role Summary

As Medical Rules Senior Manager, you will manage product image and development through the client interface by connecting Content and Business teams (BDU) simultaneously. Your role includes ensuring adherence to market billing standards and protocols, collaborating with payers, regulators, healthcare providers, and revenue cycle departments to analyze coding/billing issues, and improving rules logic to reduce denial trends.

Primary Responsibilities

• Act as a bridge between the internal THYNK product team and management to communicate vision and development priorities.
• Partner with existing and potential clients to convey product updates and gather requirements.
• Liaise with internal teams regularly and review activities to support the vision of the management.
• Develop functionalities that best support the product, aligning with market practice.
• Work effectively under pressure and report to multiple lines of management simultaneously.
• Validate monthly with the analysis team and review claim remittance reports across all payers, providing feedback to update the rule engine and decrease denial trends.
• Analyze and review bypass reports with end‑user feedback to improve rules logic, quality, and accuracy.
• Review clients’ historical denial reports to establish trend analysis and target rules content for revenue integrity.
• Apply effective written and spoken communication skills to analyze market insights and best practices, producing accurate representations of issues and proposed solutions in Rules Content definitions.

Job Requirements

• Minimum 10 years of experience in the claim adjudication lifecycle and Insurance Payer or TPA roles.
• Experience with data analytics packages such as Power BI preferred.
• Excellent analytical skills and attention to detail.
• Understanding of insurance adjudication guidelines and protocols to enrich the KSA Medical Rules repository.
• Professional certification in Medical Coding is a plus but not mandatory.
• Knowledge of KSA local market regulations and claims adjudication protocols.
• Excellent verbal, written, and presentation communication skills.
• Proficiency in Healthcare Information Systems.
• Medical training as Doctor, Nurse, or Pharmacist desirable.
• Certifications in Insurance and project management desirable.