Claims Manager (Saudi National)

MedNet Saudi Arabia (MN-KSA) BU; Jeddah; On-site; SAR 120,000 - 150,000; Full time

Job summary

A leading managed care service organization is seeking a Claims Manager in Jeddah, Saudi Arabia. The successful candidate will manage claims processing operations, maintain client relationships, and ensure superior claims handling services. Applicants should have at least 8 years of experience in claims processing, with a focus on managerial roles, and possess awareness of medical coding. This role requires Saudi Nationals. Competitive compensation and career growth opportunities await.

Qualifications

• 8 years' experience in claims processing with 4 years in managerial/supervisory level.
• 5 years of experience in a similar environment with at least 2 years in senior supervisory level.
• Saudi National only.

Responsibilities

• Plan resources, manage and control claims processing operations.
• Settle claims as per prescribed financial authorities.
• Act as an external auditor for claims approvals above defined level.
• Maintain close rapport with major clients to discuss claims and procedures.
• Act as contact person for troubleshooting claims issues.
• Motivate subordinates and improve claims processing systems.
• Maintain business relationships with clients and service providers.
• Supervise claims processing reports preparation.

Skills

Claims processing

Management

Client relations

Problem-solving

Medical coding awareness

Education

Diploma in business management or Para-Medical Courses

Job description

Job Description

MedNet 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 MedNet 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 MedNet’s revenue targets and overall business objectives.

Your Job

• 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 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 MedNet Group policies and standards, and department requirements.

Your profile

• 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