Medical Insurance

3 weeks ago

المملكة العربية السعودية, Saudi Arabia Nahdi Full time

Establish, Leading and developing the Medical Insurance Business strategy, corporate sales function to sign credit sales deals and Revenue Cycle Management (RCM) to achieve 80% revenue of group of polyclinic by representing company negotiating and signing insurance contracts and expansions of network to ensure achieving the business targets for the organization.

Minimize the rejections of claims to the mínimal to achieve profitability by setting right system of claiming and billing, handling the complaints from the medical insurance patients and managing the approval and revenue realization from the medical insurance channel of business. Building strategic partnership with insurance and big accounts companies as commercial representative of the Nahdi care clinics.

**Accountabilities**
- Plan, develop and manage strategy for 80% of clinic revenue by scanning business opportunities with insurance and corporate sales the relationship to ensure drawing good volume of business.
- Ensure achieving the planned financial target for the organization and enhancing the portfolio of services offered for the medical insurance patients.
- Develop the network of medical insurance providers that the organization is dealing with to ensure the achievement of the business targets.
- Draft, pass for approval, review and execute all the contracts of the medical insurance providers to ensure that the clinic is efficiently managing the relation with them and ensure the regular cash flow.
- Responsible for the claim preparation, submission and follow up on time to avoid any loss of revenue.
- Analyze, review and supervise to ensure the proper reconciliation of accounts with the medical insurance providers on time.
- Submission of prior approvals inline with CCHI regulations and guide line to avoid any possible penalties or loss of revenue.
- Work on promoting and marketing the business by developing the communications with the concerned parties and organizing such as health events in headquarters and big malls to increase the attraction to the clinics and build good relationships.
- Develop and deliver an effective training for the reception, call center and medical staff about the different insurance coverages offered and supported by the clinic so they can handle all the questions from the patients and customers.
- Respond and act as an escalation line for all issues or complaints related to the insurance patients and have to make sure of solving all the complaints within the agreed time frame.
- Submit recommendations related to enhancing the services offered to the insurance patients for the top management’s approval
- Support and contribute in the budget planning and forecasting exercise for the clinic.
- Handle and settle all the claim disputes.
- Ensure performance management and coaching procedures are applied to his team to allow proper and objective judgment and decisions related to the organization’s employees.
- Support and collaborate with HR the effective and proper learning and development for his team.

The employee’s duties are not limited to the above-mentioned accountabilities. The manager can assign other duties based on the business need.

**Work Environment**
- Indoors : 70%
- Outdoors : 30%
- Working Days : 6 Working Days
- Days off : 1 Days Off
- Working Hours : (8 or 9) AM to (5 or 6) PM with 1 hour break (flexible working hours)

**Job Requirement**

**Education
- Qualified Medical Doctor or Pharmacist.**Experience
- 5 years in Sales and Medical insurance role.**Computer Skills
- Microsoft Office**Languages
- English and Arabic (fluent speaking and writing)

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