H&B Claims Executive

WTW; Al Khobar; On-site; SAR 30,000 - 70,000; Full time

Job summary

An established industry player is seeking a detail-oriented claims processor to manage medical insurance claims effectively. This role requires a proactive individual who can ensure compliance and accuracy while delivering timely resolutions. The ideal candidate will have a strong client-oriented approach, excellent communication skills in both English and Arabic, and a knack for problem-solving. Join a dynamic team that values continuous improvement and operational excellence, and make a significant impact in the healthcare insurance sector.

Qualifications

• Minimum 2 years of experience in a similar role.
• Excellent proficiency in both English and Arabic.

Responsibilities

• Accurately review and process medical claims in line with policy terms.
• Communicate with clients and healthcare providers to resolve queries.

Skills

Critical Thinking

Problem-Solving

Client Orientation

Negotiation Skills

Presentation Skills

Education

Postsecondary Education

IFCE Certification

Tools

Microsoft Office

Job description

Description

Managing and processing medical insurance claims, ensuring accuracy, compliance, and timely resolution. This role involves reviewing claim documentation, coordinating with healthcare providers and insurers, and addressing client inquiries to deliver efficient and effective claim management.

The Role

Client Service & Day to Day Operations

1. Accurately review, validate, process, and adjudicate medical claims in line with policy terms and company procedures.
2. Ensure turnaround time (TAT) and timely delivery to clients.
3. Communicate with policyholders, healthcare providers, and insurers to resolve claims-related queries.
4. Provide clear and timely updates on claim status to clients.
5. Educate clients on policy coverage, exclusions, claims process, and requirements.
6. Prepare and submit reports on claim resolutions and outstanding issues.
7. Investigate discrepancies and irregularities in claims.
8. Handle disputes and resolve issues.
9. Collaborate with Senior Claims Manager for specialized cases.

Operational Risk

1. Maintain detailed and organized records of claim activities.
2. Implement control procedures.
3. Ensure implementation of WTW standards.
4. Follow WTW processes and be responsible for own results.

Organization, People & Stakeholder Management

1. Serve as the point of contact for queries from clients, insurers, and internal teams.
2. Collaborate with departments and maintain process efficiency.
3. Build successful relationships with employees, clients, and insurers.

Business Improvement & Operational Excellence

1. Implement process quality within the turnaround time.
2. Identify areas to enhance the process.
3. Embed and promote a continuous improvement environment.

Qualifications

The Requirements

• Postsecondary education.
• IFCE certification.
• Minimum 2 years of experience in a similar role.
• Excellent proficiency in both English and Arabic.
• Proficiency in Microsoft Office (Excel, Word, PowerPoint).
• Client-oriented, innovative, and critical thinking skills.
• Problem-solving and solution-oriented mindset.
• Good presentation and negotiation skills.