Medical Claims Manager

MedNet Global Healthcare Solutions LLC; Manama; On-site; BHD 30,000 - 60,000; Full time

Job summary

MedNet Bahrain is seeking a Manager - Medical & Claims to lead our medical authorizations and claims operations, ensuring high-quality, efficient, and customer-centric service across authorizations, claims adjudication and medical governance.

The role requires strong leadership, clinical expertise and a proven ability to optimize medical costs while maintaining compliance with regulatory requirements and service standards.

Qualifications

• Medical degree and active license to practice.
• Minimum 6 years of clinical practice with at least 3 years in TPAs/health insurance or managed care.
• Proven leadership of operational or medical teams.
• Strong understanding of health insurance operations, authorizations, and claims adjudication.

Responsibilities

• Lead Medical Authorizations and Claims teams to deliver high performance and KPIs.
• Oversee medical authorizations review for alignment with guidelines and policy terms.
• Manage end-to-end claims operations including timely settlement.
• Drive cost containment through utilization management and evidence-based decisions.
• Ensure SLAs and quality metrics are met and governance frameworks observed.
• Build relationships with clients, insurers, providers and stakeholders.
• Lead continuous improvement and staff development.

Skills

Clinical leadership

Stakeholder management

Analytical thinking

Communication skills

Education

Medical Degree (WHO-recognized university)

Job description

Are you a qualified medical professional with a passion for operational excellence, healthcare management and delivering exceptional customer outcomes? Do you enjoy leading teams, driving continuous improvement and making a meaningful impact within the health insurance industry?

We are looking for a Manager - Medical & Claims to join MedNet Bahrain. This is an exciting opportunity to lead our medical and claims operations, ensuring the delivery of high-quality, efficient and customer-centric services across authorizations, claims management and medical governance.

As a key member of the business, you will oversee critical operational functions, drive service excellence, and work closely with healthcare providers, insurers, clients and internal stakeholders to optimize outcomes, manage medical costs and enhance the customer experience.

Your Role

• Lead and manage the Medical Authorizations and Claims teams, ensuring high performance, service excellence and adherence to operational KPIs.


• Oversee the review and approval of medical authorizations, ensuring decisions are aligned with clinical guidelines, policy terms and best medical practices.


• Manage end-to-end claims operations, ensuring accurate, timely and consistent claims assessment and settlement.


• Drive medical cost containment initiatives through effective utilization management and evidence-based decision making.


• Monitor service delivery standards and ensure compliance with agreed service level agreements and quality metrics.


• Build and maintain strong relationships with clients, insurers, healthcare providers and other key stakeholders.


• Identify opportunities to improve operational efficiency, customer service and process effectiveness through continuous improvement initiatives.


• Lead, mentor and develop team members, fostering a culture of accountability, collaboration and professional growth.


• Support the implementation and enhancement of operational policies, procedures and governance frameworks.


• Ensure compliance with regulatory requirements, internal controls and company standards.


• Collaborate with cross-functional teams to deliver strategic projects, business improvements and operational excellence initiatives.


• Analyse operational performance and management information to support informed decision-making and business growth.

Your Profile

• Medical Degree from a university recognised by the World Health Organization (WHO).


• Minimum 6 years of clinical practice experience, including at least 3 years within a TPA, health insurance or managed healthcare environment.


• Previous leadership experience managing operational or medical teams.


• Strong understanding of health insurance operations, medical authorizations, claims adjudication and healthcare regulations.


• Excellent analytical and problem-solving skills with the ability to make sound medical and commercial decisions.


• Proven ability to manage stakeholders and build effective relationships across multiple functions.


• Strong communication and interpersonal skills with the ability to influence and collaborate at all levels.


• Commercially minded with a focus on balancing customer satisfaction, medical governance and cost management.


• Results-driven, proactive and committed to continuous improvement.


• Ability to work effectively within a fast-paced, multicultural environment.

At Munich Re & MedNet, we embrace, and value, the interaction of diverse backgrounds, experiences, perspectives and thought. This interaction is our foundation. Of our open culture and spirit of partnership. Of how our teams are built and cultivated. Of how we are supported and developed. And at the centre of this interaction is each of us