H&B Senior Claims Manager
WTW
Date: 3 days ago
City: Riyadh
Contract type: Full time
Description
The Role
The Requirements
WTW is an equal opportunity employer
The Role
- Lead the claims team for his/her region in KSA, responsible for employee benefits claims. This includes managing staff performance, providing guidance, and ensuring the department meets service level agreements and regulatory standards.
- Oversee the claims process for H&B in his/her region in KSA, ensuring that it follows the H&B operating model, and claims are processed efficiently and fairly. This includes working with insurance carriers to expedite claims resolution and ensure compliance with policy terms. Ensure that clients are kept informed throughout the claims process.
- Serve as the first escalation point for employers regarding claims issues. Work to resolve any client concerns and issues. Provide updates to clients until claims issues are resolved.
- Serve as the main H&B claims consultant for employers. Provide expert advice on claims-related inquiries and work to resolve any client concerns. Ensure that clients are kept informed throughout the claims process.
- Serve as the main point of contact for other departments within the H&B team regarding claims issues, and ensure adherence to turnaround times stipulated by SLAs between H&B and clients.
- Handle complex or escalated claims, negotiating with insurers, healthcare providers, and legal teams when necessary. Work to resolve disputes or issues that may arise during the claims process. Provide insight on medical reports when needed.
- Ensure that all claims handling complies with local regulations and other relevant laws. Stay updated on regulatory changes affecting employee benefits claims.
- Provide regular reports to H&B Placement Team and H&B Client Management Team on claims performance, identifying trends and making recommendations for improvement. This can also involve analyzing claims data to identify potential cost-saving opportunities.
- Work closely with the wider H&B team to provide insights on claims experience, assist with renewal negotiations when needed, and help tailor benefits packages based on claims trends.
- Build and maintain relationships with insurers and third-party administrators (TPAs) to ensure efficient claims handling and resolution. Negotiate favorable terms where necessary.
- Assist employers in understanding the claims process and their employees’ benefits, providing training or materials to help them navigate the system effectively.
- Continuously review and improve the H&B claims handling processes to enhance client satisfaction and operational efficiency. Explore innovative solutions such as digital claims handling or automated claims systems.
The Requirements
- Bachelor's Degree
- Medical Degree is preferred
- Min. 5 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
- Stage 1: Online application and recruiter review
- Stage 2: Interview with hiring manager and team
- Stage 3: Offer and onboarding
WTW is an equal opportunity employer
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