Description:
As a Medical Claims Manager, you will be responsible for managing the medical claims process, ensuring accurate and timely processing, and managing relationships with internal and external stakeholders.
RESPONSIBILITIES:
- Oversee the medical claims process, including reviewing and adjudicating claims, ensuring compliance with regulatory requirements and company policies, and managing claims staff and vendors
- Monitor and analyze claims data to identify trends, patterns, and opportunities for process improvements and cost savings
- Develop and maintain relationships with healthcare providers, insurance carriers, and other stakeholders to ensure optimal claims processing and resolution
- Develop and maintain claims processing procedures, workflows, and systems to ensure accuracy, efficiency, and compliance with regulatory requirements
- Collaborate with other departments, including finance, legal, and compliance, to ensure timely and accurate claims processing and resolution
- Provide exceptional customer service to policyholders and other stakeholders, responding to inquiries and concerns in a timely and professional manner
- Develop and deliver training programs for claims staff and other departments as needed
- Manage the claims budget, monitor expenses, and provide regular reporting and analysis to senior management
- Maintain knowledge of industry trends, market developments, and regulatory changes that impact medical claims management
- Participate in industry conferences and events to stay abreast of best practices and emerging trends in medical claims management
REQUIREMENTS:
- Bachelor’s degree in Healthcare Administration, Business, or a related field
- Minimum of 5 years of UAE experience in medical claims management
- Strong knowledge of medical claims procedures, workflows, and regulations
- Excellent analytical, communication, and problem-solving skills
- Demonstrated ability to work effectively in a team environment, collaborate with other departments, and build strong relationships with stakeholders
- Proficiency in Microsoft Office and claims management software programs
- Professional designations such as CPCU, ARM, or AU are a plus