H&B Claims Executive

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

Organization, People & Stakeholder Management

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

Business Improvement & Operational Excellence

• Implement process quality within the turnaround time
• Identify areas to enhance the process
• Embed and promote a continued improvement environment
  
  

Qualifications

The Requirements

• Postsecondary education
• IFCE certification
• Min. 2 years working experience at similar role
• Excellent proficiency in both English and Arabic
• Proficiency in Microsoft Office (Excel, Word, PowerPoint).
• Client-oriented, innovative and critical sense
• Problem-solving and solution-oriented
• Good presentation and negotiation skill