H&B Claims Executive

Towers Watson India Pvt. Ltd; Eastern Province; On-site; SAR 30,000 - 60,000; Full time

Job summary

An established industry player is seeking a detail-oriented Claims Processor to manage medical insurance claims efficiently. This role involves validating and adjudicating claims while ensuring compliance with policy terms. You will serve as a vital point of contact for clients and healthcare providers, resolving queries and educating clients on their coverage. With a focus on continuous improvement, you will collaborate with various departments to enhance operational efficiency. If you possess strong problem-solving skills and are proficient in both English and Arabic, this opportunity could be your next career step.

Qualifications

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

Responsibilities

• Accurately review and process medical claims according to policy terms.
• Communicate with clients and insurers to resolve claims-related queries.

Skills

Client-oriented

Critical thinking

Problem-solving

Negotiation skills

Education

Postsecondary education

IFCE certification

Tools

Microsoft Office

Job 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 (TAT) turnaround time & 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 process and be responsible for own results

Organization, People & Stakeholder Management

1. Serve as a 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

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