Bachelor degree in Medicine, 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 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 Excel
Presentations.
Fluent business English (verbal and written skills)
Job Duties and description:
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 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
the
company policies and standards, and department
requirements
CLAIMS SUPERVISOR
Qualifications:
All applicants must have strong analytical skills
and
knowledge of computer systems and CPT-4 and also
ICD-10
AM coding terminology.
Continuing education in all areas affecting group
health
and welfare plans is required.
Applicants must demonstrate the ability to supervise
tasks and contribute to the Team atmosphere and
concept
Applicants must have a minimum of 5 years of medical
claims analysis and adjudication experience
(including
dental and optical claims analysis).
Prior experience in management and training is
preferred
but not required.
3 – 5 years’ supervisory experience.
Experience in the insurance industry preferred.
Strong project management, customer care experience.
Strong leadership and strong communication skills,
both
verbal and written.
Strong organizational, multi-tasking, time
management
skills.
Demonstrates excellent interpersonal skills.
Ability analyze, solve problems and adjust to
changing
priorities
Experience with Microsoft office suite including
Excel,
Word and Visio.
Job Duties and description:
Manage direct reports, the team work flow and
evenly
distribute and reassign tasks as necessary.
Responsible for the Quality Reviews of each team
member.
Promote and maintain a team-oriented
environment.
Motivate team members and assist in setting
individual goals and department performance
standards.
Responsible for the training of new hires as
well as
ongoing development and refresher training of
all
team members.
Responsible for the transition of accounts from
one
team member to another.
Handle escalated requests and manage work
overflow
of claims during times of peak activity.
Identify and implement procedures that help meet
the
department goals
Identify and report troubled areas to management
to
enhance performance and increase productivity by
reviewing management information reports,
backlog
reports and department standards
Completes annual performance appraisals for team
members
Monitor team attendance according to
departmental
standards.
Initiate Corrective Active or the Performance
Improvement Process as needed.
Assists in interviewing and hiring process
Liaison with Customer Service and Marketing.
Responsible for maintaining the File Room and
the
scanning process
Other duties as assigned.
CLAIMS AUDITOR
Qualifications:
Experience in overturning claim denials - ranging
from
simple solutions such as coding correction to more
complex ones involving submission of appeals and
grievances
The desire to be part of a team of professionals
that
has fun while really making a difference to our
clients.
Proficient with Microsoft Office.
Ability to think outside the box with excellent
time-management skills.
Ability to multi-task, while working with a sense of
urgency.
Knowledge of CPT/ ICD 10 AM and ACHI is required.
Coding
Certificate a plus.
Excellent communication and customer service skills
-
must be able to communicate effectively with
Clients,
Insurance Companies, and Providers both in writing
and
over the phone.
Job Duties and description:
Reviewing patient medical bills, correspondence
and
EOB's for accuracy
Communicating with Insurance Companies and
Providers
to address any issues that are identified (e.g.,
appeal incorrectly denied claims, coordinate
with
providers to fix billing errors, negotiate with
providers in the case of inappropriate billing)
Communicating with clients via phone and email -
responding to client requests in a timely and
professional manner, going above and beyond to
make
sure their concerns are addressed and that
medical
bills and associated paperwork is no longer a
worry
for them
Provide client support with benefit/health
insurance
questions
Identifies problems and inconsistencies by using
management reports
Summarizes findings and makes recommendations to
resolve claims/billing issues
APPROVAL MANAGER
Qualifications:
Bachelor Degree in Medicine is a must
Business Management Certificate or equivalent is a
plus
8 years’ experience; preferably in the health
insurance
field
Microsoft Office: proficiency in Excel & word
Analytical thinking
Costumer focus
Job Duties and description:
Plan and direct the operation of Medical
Approval
Team in accordance with the department
objectives
Prepare department’s yearly budget, plans and
suggest recommendations.
Analyze prior-approval requests, negotiate the
cases
with the providers when necessary and approve
payment against Pre-approvals on medical cases
Ensure that medical cases and customers queries
are
solved in accordance with Company quality
standards
in order to reach customer medical necessity and
satisfaction
Consult the Global Clinical Team Experts for
complicated medical cases.
Cascade Company objectives to the team leaders,
ensure proper communication on new projects and
new
services; facilitate the workflow between the
Medical Approval Department and all other
departments
Review and analyze Medical service activities
and
data in order to support planning and risk
management and to improve service utilization
Prepare monthly statistical reports to
Operations
Manager related to department operation, budget
and
cost containment, customer and provider
complaints
and medical cases.
Report regularly the team’s performance to
operations Manager.
Appoint Team Leaders, assign responsibilities,
set
objectives and assess their performance to
measure
achievements against these objectives.
Coach, develop and guide the Team Leaders
Ensure that Company core competencies, values,
and
policies are implemented across the Department
teams
Support the Team Leaders in the process
re-engineering and update
Miscellaneous tasks within the scope of work, as
assigned by the direct manager.
APPROVAL OFFICER
Qualifications:
Bachelor Degree in Pharmacy or Medicine or dental.
Working on Rotational Shifts upon schedules based on
work need.
Very good command of English language
The ability to communicate sensitively and
effectively with claims department and other
departments having regard for the strict need for
confidentiality
Advanced knowledge of Microsoft office (Word,
PowerPoint, and Excel) e-mail, electronic calendar
and the Internet.
Ability to work well with all levels of internal
management and staff, as well as outside clients and
users.
Attending e-mails from insurance companies or
clients.
Coordinating with all providers for direct
billing.
Increasing efficiency, minimizing errors and
administration time.
NETWORK RELATIONS MANAGER
Qualifications:
Strong verbal and written communication,
interpersonal, problem resolution and critical
thinking skills with proven ability to influence and
collaborate with providers and partners at all
levels.
7+ years' experience in business segment specific
environment servicing or managing non-standard
relationships with providers with exposure to
benefit plan design and/or contract interpretation.
3-5 years' experience with business segment specific
policy, benefits, plan design and language.
Fluency in English (MUST) and Arabic language is
preferred due to territory needs
Working knowledge of business segment specific
products, and terminology
Bachelor Degree in Pharmacy or Medicine or dental.
Job Duties and description:
Optimizes interactions with assigned providers
and internal business partners to establish and
maintain productive, professional relationships
and partners on the development of business
strategy and programs to support the operational
plans.
Collaborates cross-functionally to ensure
resolution of escalated issues or projects for
assigned provider systems and monitors
performance based on defined KPI’s.
Educates internal and external parties as needed
to ensure compliance with contract policies and
parameters, plan design, compensation process,
technology, performance measurement techniques,
policies, and procedures.
Meets with key providers periodically to ensure
service levels are meeting expectations. Manages
the development of agenda, validates materials,
and facilitates external provider meetings.
May collaborate cross functionally on the
implementation of large provider systems, to
manage cost drivers, data reports and execute
specific cost initiatives to support business
objectives and to identify trends and enlist
assistance in problem resolution
May collaborate cross functionally on the
implementation of large provider systems, to
manage cost drivers, data reports and execute
specific cost initiatives to support business
objectives and to identify trends and enlist
assistance in problem resolution
May provide guidance and training to less
experienced team members.
NETWORK RELATIONS SUPERVISOR
Qualifications:
Bachelor Degree in Nursing Science, Pharmacy,
Paramedical certificate or any medical related
fields such as hospital management or medical
record.
From 1 to 3 years' experience in the Insurance
field.
Experience in Network and or claims management in
the insurance industry or a TPA/SMO company would be
a plus.
Computer literacy (MS Office, Excel, PowerPoint).
Knowledge related to medical terminology.
Ability to handle stress.
Quality focus and customer oriented.
Good interpersonal and negotiation skills
Job Duties and description:
Direct customer services to the insured member
at the hospital offices in order to achieve
better facilitation and enhancement for customer
journey
Actively solicit and gather customer feed backs
in order to improve service levels. Use multiple
channels including (but not limited to) periodic
customer satisfaction surveys and personal
interactions.
Conduct daily visits to admitted insured members
(In hospital) to collect their feedback.
Refer insured member or provider's grievances
when required to the concerned / designated
departments for further investigation.
Periodically notify the insured member or
provider about the progress of the complaint
investigations, results and any planned
adjustments.
Where necessary conduct independent
investigations to determine the causes of
complaint
Recommend improvements in services or
procedures or products in order to prevent
future problems.
Comply with internal complaint escalation
protocols if a case is delayed or not resolved
in an appropriate or time-bound manner, by the
designated department
CUSTOMER SERVICE MANAGER
Qualifications:
5+ years’ experience managing a high-volume call
center / customer service environment.
Develop and implement plans for continuous process
improvement.
Bachelor’s Degree preferred.
Demonstrated passion for continuous improvement and
service excellence.
Strong leadership/supervisory skills. Excellent
written, verbal and interpersonal skills.
Excellent written, verbal and interpersonal skills.
Excellent problem-solving skills.
Sound judgment to effectively balance business
priorities and stakeholder needs.
Bilingual in English is a plus.
Job Duties and description:
Hire, train, and develop call center employees.
Handles all facets of performance management
including performance evaluations and corrective
action.
Provides support and guidance to team members.
Regularly provides performance feedback based on
review of quality reports/quality monitoring and
production results
Directs workflow to insure maximum efficiency
and attention to areas of greatest importance.
Handles high priority and escalated calls.
Handles regular calls when needed to maintain
SLAs.
Dispositions work to CSRs based on special
instructions and provides approvals where
necessary.
Review and analysis of reports
Researching or gathering information for audits.
Working with peers and manager to communicate
changes to CSRs (e.g., systems enhancements,
changes to guidelines and processing
requirements, etc.)
Handling follow-up with agents/clients as needed
related to Voice of the Customer reports
CUSTOMER SERVICE SUPERVISOR
Qualifications:
Associate’s degree or equivalent combination of
formal training and experience
At least 3 years of supervision experience preferred
Strong leadership skills with the ability to guide,
direct, train and interact with staff and clients
Demonstrate knowledge of third-party and insurance
companies and operating procedures, regulations and
billing requirements
Working knowledge of call center systems and
processes
Self-motivated, self-directed and attention to
detail
Strategic thinker and problem solver
Strong organizational skills and the ability to
handle multiple tasks
Proven project management and time management skills
Skilled in Microsoft Office – Word and Excel
Job Duties and description:
Supervise employees to meet daily department and
supervisor productivity goals.
Review staffing levels, staff schedules and
assigning specific duties.
Works with management to establish and implement
departmental goals and processes.
Supervise the daily operations of the department
and provides leadership to employees.
Assist in determining staffing needs,
interviews, hires and works with the manager to
oversee the training of employees.
CUSTOMER SERVICE OFFICER
Qualifications:
Good command of English language.
Experience in the call center/customer service is
preferred.
Previous experience in Medical insurance industry is
a big asset
Punctual, people oriented and problem-solving skills
Discipline & strict compliance with policies &
procedures.
Ability to learn, seek knowledge and
self-development
Strong verbal communication skills.
Demonstrates a positive, enthusiastic, friendly
attitude.
Ability to work on 24 hours shift basis (flexibility for overnight
shifts for males is required)
Proficiency in using MS Office application.
Job Duties and description:
Receiving inbound calls for customer's inquiries
Understand and respond to customer needs and
issues over the phone.
Assist, advise and provide solutions to
customers
Maintaining a professional attitude.
Comply with the work standards and processes.
Meeting set monthly KPIs.
Work individually and as a part of a team.
Accountability for pending cases until resolved.
Creating CRM complaints and report any
problematic issue.
Share knowledge with colleagues and follow up
with the concerned departments to close pending
issues.
Ensure a high level of customer's satisfaction
PRODUCTION MANAGER
Qualifications:
Possess 7+ years relevant working experience in
medical insurance products.
Able to work in fast paced environment
independently, strong sense of responsibility,
detailed minded, sound judgement, good analytical
and problem-solving skills.
Good interpersonal and communication skills (written
and spoken English and Arabic)
Self-Initiative and able to work under pressure.
Well versed in Microsoft Office including use of
Word, Excel & PowerPoint.
Job Duties and description:
Being a team player of a medium business
executive team, to assist the Senior Manager in
monitor the development of Commercial Line
business to achieve the business objectives of
the Team.
Support the team to provide quality services to
designated producers including the delivery of
timely new and renewal business quotations.
Closely work with the Processing Team in
producing timely and accurate policy documents.
Assist the Senior Manager in formulating the
business plan and monitoring both top line and
bottom line of the team portfolio.
Relationship building with producers through
visitation and day-to-day contact by delivering
quality services.
Contribute and undertake projects as required
Ensure external vendors are managed consistently
and aligned to the company policy and
procedures.
Design on-going upskilling and rotation programs
to ensure skills are maintained at advanced
level
PRODUCTION OFFICER
Qualifications:
Bachelor’s Degree in Business Administration.
Strong interpersonal and analytical skills.
Demonstrate flexibility and adaptability to work in
a fast moving and challenging environment.
Proficient in MS Application (Word, Excel and Power
Point).
Intermediate knowledge of the structure and content
of the English and Arabic Language.
Job Duties and description:
Process and issue policies, endorsements,
cancellations (including generate medical cards
and update the system), certificates,
billings/invoices as well as manage pre-written
quotes for different Lines of Business.
Book adjustments of premiums for policies and
endorsements using Underwriting system.
Handle cases in the Imaging system and proper
and regular filing of supporting documents.
Attend telephone and written queries from
underwriting or business personnel.
Follow up with agencies regarding policies to be
submitted or missing information
Perform specials projects and other related
duties as assigned
