Claims Reimbursement

2 months ago

المملكة العربية السعودية, Saudi Arabia Bupa Arabia Full time

To lead and manage the operations in Regions ensuring and improving the performance, productivity and efficiency of reimbursement unit through the provision of effective methods and strategies

Operations
- Plan implementation strategy to consistently achieve set targets despite continuous change on the number of received claims VS resource availability
- Control operation processes to comply with policies and procedures
- Drive productivity by leveraging strong front office management skills
- Review operations reports and schedules to ensure accuracy and efficiency of methods and strategies applied
- Manage preparation of operation and regulatory reports based on agreed reporting metrics
- Adjudicate In-Patient claims
- Perform Quality Audit on claims
- Perform necessary analytics utilizing excel and reporting tools efficiently

Policy and Procedural Protocol Compliance
- Maintain close coordination with Jeddah office to ensure that operational processes and procedures are consistently applied and to comply with the regulations
- Maintain close coordination with sales and membership in the region to sync operations processes to adapt to reimbursement policy agreements and procedures of the group
- Perform quality assurance to ensure that contractual policies and procedures are implemented
- Perform quality control to identify variations

Process Improvement
- Continuously innovate on process improvements to drive efficiency across the reimbursement supply chain (internal and external)
- Continuously develop and update the Reimbursement Membership Pack and Reimbursement Examiners Manual to prevent inconsistencies
- Identify and quantify adjudicators performance variances, and determine appropriate preventive and corrective actions

Project Management
- Develop change requests based on project management strategies to ensure completion of project based on time, cost, scope and quality

People Management
- Ensure and facilitate goal setting; manage and constantly review individual performance
- Provide regular feedback, coaching and development
- Motivate, empower and enable direct reports by providing the necessary tools and support required to achieve the organizational development objectives

**Skills**:

- Experience in managing team
- Exposed in computerized environment

**Education**:
MBBS (Bachelor of Medicine & Surgery) with some expertise of Insurance is preferred

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