MedNet Saudi Arabia are one of the leading managed healthcare service providers for quality solutions that meet an individual’s healthcare needs. We are currently seeking to hire a Claims Manager with the following tasks and responsibilities:
Plan resources, manage and control overall claims processing operations for provider network and insured member direct, ensuring provision of prompt services to clients and thus supporting achievement of the overall MedNet Jordan goals and objectives and optimum customer satisfaction.
Settle claims as per prescribed/designated financial authorities; ensure reserves are established/maintained for reported claims as per agreed procedures and review of claims is taken up periodically.
Act as an external auditor for claims/approvals which are above the defined level in order to sign off prior to forwarding to the concerned department/ Managing Director
Maintain close rapport with major clients; visit/meet clients; discuss claims, claims procedures or other matters and adopt the best way forward for resolution of such matters.
Act as the contact person to insurance providers, members, insurance companies in order to ensure effective troubleshooting in the event of any issues regarding claims.
Motivate subordinates and identify opportunities for continuous improvement of claims processing systems, processes and practices taking into account international leading practices, improvement of business processes, cost reduction and productivity improvement.
Maintain quality of processed claims through managing claims team in applying policies & procedures along with quality measures that are set for the Claims Department.
Supervise the preparation of claims processing reports in a timely and accurate manner to meet Munich Health policies and standards, and department requirements.
Bachelor degree in Medicine, Nursing or Pharmacy or any medical field
8 years’ experience in claims processing out of which 4 years in managerial/supervisory level.
Minimum 4 years’ experience in (in/out hospital claims) processing in insurance/TPA/MSO industry
Strong leadership, planning and organizational skills
Can motivate team members.
Efficiency and productivity while working under pressure
Good knowledge of Microsoft applications, especially profound experience in developing PowerPoint Presentations
Fluent business English (verbal and written skills)