H&B Claims Executive

WTW group; Saudi Arabia; On-site; SAR 30,000 - 70,000; Full time

Job summary

An established industry player is seeking a dedicated H&B Claims Executive to manage and process medical insurance claims efficiently. This role is pivotal in ensuring accuracy and compliance while delivering timely resolutions. You will be responsible for reviewing claims, coordinating with healthcare providers, and addressing client inquiries. The ideal candidate will possess strong client-oriented skills, problem-solving abilities, and proficiency in both English and Arabic. Join a dynamic team committed to operational excellence and continuous improvement in a supportive environment.

Qualifications

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

Responsibilities

• Review, validate, process, and adjudicate medical claims.
• Communicate with policyholders and healthcare providers.

Skills

Client-oriented skills

Problem-solving skills

Negotiation skills

Critical thinking

Education

Postsecondary education

IFCE certification

Tools

Microsoft Office

Job description

# H&B Claims Executive
Al Khobar, Eastern Province, Saudi Arabia
### H&B Claims Executive

202502973
Al Khobar, Eastern Province, Saudi Arabia
Full time
Closing on: Jun 16 2025

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

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

Operational Risk

• Maintain detailed and organized records of claim activities
• Implement control procedures
• Ensure implementation of WTW standards
• Follow WTW processes and be responsible for own results

Organization, People & Stakeholder Management

• Serve as point of contact for queries from clients, insurers, and internal teams
• Collaborate with departments to maintain process efficiency
• Build successful relationships with employees, clients, and insurers

Business Improvement & Operational Excellence

• Implement process quality within turnaround time
• Identify areas to enhance the process
• Embed and promote a culture of continuous improvement

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