Manager, Medical & Claims Operations

MedNet Global Healthcare Solutions LLC; Manama; Vor Ort; BHD 36.000 - 60.000; Vollzeit

Zusammenfassung

MedNet Bahrain is seeking a Manager - Medical & Claims to lead medical authorizations, claims operations and medical governance, delivering high-quality, efficient services across the health insurance value chain.

You will manage teams, collaborate with providers, insurers and clients, drive continuous improvement, ensure regulatory compliance, and balance cost control with compassionate, patient-focused service.

Qualifikationen

• Medical Degree from a university recognised by WHO.
• Minimum 6 years of clinical practice, with at least 3 years in a TPA/health insurer/managed care environment.
• Experience leading operational or medical teams.
• Strong understanding of health insurance operations, authorizations, claims adjudication, and healthcare regulations.
• Excellent analytical and problem-solving skills with ability to make sound medical and commercial decisions.

Aufgaben

• Lead Medical Authorizations and Claims teams to ensure high performance and KPIs.
• Review and approve medical authorizations in line with clinical guidelines and policy terms.
• Manage end-to-end claims operations for timely and accurate settlements.
• Drive cost containment through utilization management and evidence-based decisions.
• Monitor service delivery standards and ensure compliance with SLAs and quality metrics.
• Build strong relationships with clients, insurers, providers and stakeholders.
• Identify opportunities to improve operational efficiency and customer service.
• Mentor and develop team members, fostering accountability and collaboration.
• Support implementation of policies, procedures and governance frameworks.
• Ensure regulatory compliance and internal controls.
• Collaborate on cross-functional strategic projects.
• Analyse performance data to inform decisions and growth.

Kenntnisse

Leadership experience

Stakeholder management

Analytical skills

Communication skills

Problem-solving

Continuous improvement mindset

Ausbildung

Medical Degree

Jobbeschreibung

MedNet Bahrain is seeking a Manager - Medical & Claims to lead medical authorizations, claims operations and medical governance, delivering high-quality, efficient services across the health insurance value chain.

You will manage teams, collaborate with providers, insurers and clients, drive continuous improvement, ensure regulatory compliance, and balance cost control with compassionate, patient-focused service.