Senior Manager, Medical Claims & Value-Based Care

Tawuniya; Riyadh; On-site; SAR 300,000 - 500,000; Full time

Job summary

Tawuniya is seeking a Lead, Medical Claims to steer the claims adjudication team, ensure compliant and timely processing, and drive cost-optimisation and value-based healthcare initiatives. You will guide improvements, mentor staff, and collaborate with stakeholders to uphold quality of care and operational performance.

Ideal candidate has 6+ years in health insurance/medical claims, with a medical background and postgraduate management qualification being a plus.

Qualifications

• Minimum 6 years of experience in Health Insurance, preferably in medical claims.
• 2 years of experience in the medical field.

Responsibilities

• Lead the Medical Claims team to deliver accurate, compliant adjudication.
• Drive timely claims processing and cost optimization initiatives.
• Coordinate workload planning and performance management.
• Ensure adherence to policies, procedures and quality standards.
• Communicate with stakeholders to resolve issues and maintain operations.
• Identify opportunities for process improvements and automation.
• Support VBHC, DRG and PHM initiatives to optimize care quality and costs.
• Coach and train team members to achieve targets.

Skills

Medical field experience

Health Insurance/Medical claims

Education

Bachelor of Medicine and Surgery

Postgraduate management degree (a plus)

Job description

Tawuniya is seeking a Lead, Medical Claims to steer the claims adjudication team, ensure compliant and timely processing, and drive cost-optimisation and value-based healthcare initiatives. You will guide improvements, mentor staff, and collaborate with stakeholders to uphold quality of care and operational performance.

Ideal candidate has 6+ years in health insurance/medical claims, with a medical background and postgraduate management qualification being a plus.