Senior Executive Director

6 months ago

Riyadh, Saudi Arabia Intelligent Solutions HR Consultancy Full time

**General Overview**:
**Key Responsibilities**:

- Lead the establishment and execution of the Department’s annual plan, budget, objectives and initiatives in line with the company's strategic objectives and set KPIs.
- Direct the department’s operations and activities within budget and devise strategies that result in a positive financial impact.
- Oversee provider network and build long-lasting relationships with providers to deliver cost-effective and efficient services to customers.
- Facilitate and manage the audit and reconciliation process, ensuring the use of clear supporting documents for claim costs, and prompt detection and assessment of fraudulent activities.
- Intervene in critical negotiations with providers to agree on price lists and establish processes (i.e., billing, claims, etc.), and oversee provider contracts ensuring adherence to the Business needs.
- Oversee capability building and saving programs and provide input to maximize effectiveness in reducing costs and increasing profitability.
- Ensure claims management processes (i.e., pre-authorization, reimbursement, etc.) and medical treatment assessments are in line with pre-set guidelines, procedures, and regulations.
- Ensure the adjudication of claims are accurate based on the medical and technical claims assessment.
- Oversee fraud management system controls and coordinate with Planning and Quality to validate their compliance and effectiveness.
- Oversee processing and justification of Health claims ensuring adherence to relevant guidelines and regulations set by CCHI, MoH, etc.
- Leverage medical data analyses and KPI results to direct action plans to bridge gaps and drive operational excellence.
- Keep abreast of latest updates in the delegation of authority (DoA) to ensure all operations handled by Policy Administration function are compliant with the pre-set mandate and scope of work.
- Facilitate coordination with Underwriting to ensure timely escalation of policy administration requests when repricing/risk reassessment are needed.
- Refine the organization's strategy in alignment Ministry of Hajj and Umrah.
- Guide relationships and facilitate interactions as needed with external stakeholders such as third-party administrators (TPA), Ministry of Health, Ministry of Finance, CCHI, SAMA, Ministry of Hajj and Umrah, brokers etc. to ease collaboration.
- Oversee Hajj and Umrah activities related to portfolio management, claims review/approval, etc. ensuring alignment with relevant guidelines, risk levels, and financial capability.
- Ensure continuous performance improvement of operations based on latest gaps and objectives.
- Direct the development of the Department’s policies, processes and procedures to increase productivity, attain high quality outputs, and cost effective results in line with relevant regulatory requirements.
- Lead the development, enhancement and implementation of control systems, and the resolution of escalated non-compliance cases.
- Direct the department’s talent acquisition, development and management activities.
- Lead setting team members’ objectives, clarifying expectations, reviewing performance periodically, providing regular feedback, coaching, and confronting unsatisfactory behavior or performance.
- Promote a high-performance and an accountable working environment.

**Requirements**:

- A Bachelor’s Degree in Medicine, Accounting, Finance, or equivalent is required.
- A Master’s Degree in Business Administration, Accounting, Finance, or equivalent is preferred.
- Minimum 13 years of experience in the field of health insurance with at least 6 years of experience in a managerial position.

Industry

Insurance

City

Riyadh

Province

Riyadh

Country

Saudi Arabia

Postal Code

11564

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