Claims Manager; Saudi National

Job Description

Med Net is one of the leading managed care service organizations that caters to healthcare needs and offers protection against unforeseen health risks. We are looking for a Claims Manager who will plan and manage the data entry and claims processing operations of the assigned Med Net in order to ensure the delivery of superior claims handling services to customers within the defined turnaround times (TAT) in accord with established policies and corporate guidelines in order to support the achievement of Med Net’s revenue targets and overall business objectives.

• 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 Med Net Saudi Arabia 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 effective business relationships with clients and all service providers (including hospitals, all medical institutions, brokers etc) to ensure the services required by the organisation are delivered in the most effective manner.
• Supervise the preparation of claims processing reports in a timely and accurate manner to meet Med Net Group policies and standards, and department requirements.

• Diploma in business management or Para-Medical Courses is preferred.
• 8 years' experience in claims processing out of which 4 years in managerial/supervisory level.
• 5 years of experience in a similar environment with at least 2 years in a senior supervisory level in claims management.
• Awareness of the medical coding
• Saudi National only