Claims Reimbursement

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