Medical Claims Manager
3 weeks ago
Summary:
Main Tasks:
- Serve as the acknowledged expert and information source for staff
- Follow medical guidelines, practices and regulator ( AI ) instructions.
- Setting goals and Priorities for medical team and Provide feedback about areas for improvement
- Respond to employee questions / concerns on individual basis as needed
- Conduct and schedule staff development opportunities
- Organized Establishment of effective cost containment plans, Case management and Cost Saving for jumbo cases and high cost management ( referral and special discount )
- Update Network Department with providers having issues with Codes and Price, Referral Matrix and Centers of Excellence
- Raise suspected fraud and abuse provider to Network and Fraud, Waste and Abuse ( FWA ) departments
- Provide accurate analytic Data; insights and recommendations to multiple stakeholders
- Monitor adherence to policies and established procedures
- Meet the qualitative requirements and continuously work to improve quality of approvals.
- Monitoring of the daily dashboard to ensure adherence to SLA, TAT and the productivity
- Assist clients with escalated queries and provide suitable query resolution for other departments
- Ensuring participative leadership and strong communication within the team
- Coaching and team Development with quality assurance and trending
- Regular evaluation and root cause analysis for department enhancement
- Increase automation percentage and accuracy and review the rules
Minimum Requirements:
- Bachelor of Medicine and Bachelor of Surgery MBBS
- 8+ years of experience in a mid-to-large sized organization in the similar role.
- SCFHS
- Typing and communication skills in English & Arabic.
- Physically fit to carry out duties.
**Job Level**:
- Management
**Location**:
- Khobar, SA
**Area of Expertise**:
- Operations
**Unit**:
- Allianz Partners
**Employing Entity**:
- Nextcare Saudi Arabia
**Job Type**:
- Full-Time
**Remote Job**:
- 100% on-site
**Employment Type**:
- Permanent
**ID**:
- 67744
**Position Cluster**:
-
Medical Claims Manager
3 weeks ago
الخبر, Saudi Arabia Allianz Full timeMedical Claims Manager (Approvals) - Serve as the acknowledged expert and information source for staff - medical guidelines, practices and regulator ( AI ) instructions. - Setting goals and Priorities for medical team and Provide feedback about areas for improvement - Respond to employee questions / concerns on individual basis as needed - Conduct and...
-
Asst. Human Resources Manager
5 days ago
الخبر, Saudi Arabia Marriott International, Inc Full time**Additional Information** **Job Number**24216826 **Job Category**Human Resources **Location**Marriott Executive Apartments Al Khobar, Building No 7791 Prince Hammoud Bin Abdul Aziz Street., Al Khobar, Saudi Arabia, Saudi Arabia **Schedule**Full Time **Located Remotely?**N **Position Type** Management **JOB SUMMARY** As a member of the property Human...
-
Medical Secretary/medical Assistant
2 days ago
الخبر, Saudi Arabia Talent House Co. Full time**Key Responsibilities**: - Assist in scheduling and organizing meetings with healthcare clients - Maintain accurate and up-to-date records of client information and project documentation - Prepare reports, presentations, and other documents for the consulting team - Manage the administrative aspects of client engagements, including contracts, billing, and...
-
Mgr-human Resources I
3 days ago
الخبر, Saudi Arabia Marriott International, Inc Full time**Additional Information** **Job Number**24184671 **Job Category**Human Resources **Location**Marriott Executive Apartments Al Khobar, Building No 7791 Prince Hammoud Bin Abdul Aziz Street., Al Khobar, Saudi Arabia, Saudi Arabia **Schedule**Full Time **Located Remotely?**N **Position Type** Management **JOB SUMMARY** As a member of the property Human...
-
Senior Medical Representative
1 week ago
الخبر, Saudi Arabia AstraZeneca Full time**JOB TITLE** **Senior Medical Representative** **ABOUT ASTRAZENECA** AstraZeneca is a global, science-led, patient-focused biopharmaceutical company that focuses on the discovery, development, and commercialisation of prescription medicines for some of the world’s most serious diseases. But we’re more than one of the world’s leading pharmaceutical...
-
Project Manager
1 day ago
الخبر, Saudi Arabia greenclover Full timeProven experience in managing large-scale EPC projects, particularly in theexecution of SWRO and STP projects.▪ Strong technical knowledge in Mechanical, Process, Electrical &Instrumentation (E&I), and Commissioning works.▪ Excellent leadership, communication, and negotiation skills, Exceptionalproject management and organizational skills.▪ Ability to...
-
Construction Manager
1 day ago
الخبر, Saudi Arabia greenclover Full timeProven experience in managing large-scale EPC projects, particularly in theexecution of SWRO and STP projects.▪ Strong technical knowledge in Mechanical, Process, Electrical &Instrumentation (E&I), and Commissioning works.▪ Excellent leadership, communication, and negotiation skills, Exceptionalproject management and organizational skills.▪ Ability to...
-
Project Engineer Energy
5 days ago
الخبر, Saudi Arabia Atlas Copco Services Middle East SPC Full time**Project Engineer Energy & Petrochemical**: - Functional area: Engineering - Country: Saudi Arabia - City: Khobar - Company name: Atlas Copco Services Middle East SPC - Date of posting: Jan 19, 2025 Our solutions are a key part of most industries - electronics, medical research, renewable energy, food production, infrastructure and many more. Working with...
-
Sme Rm Field Sales
2 weeks ago
الخبر, Saudi Arabia Bupa Arabia Full timeFollow set KPI's by team leader for number of calls, visits and proposals. - Search for new leads by different sources (Net - calls - territory Management - Referrals - CRMetc). - Ensure submitting the quotation within department KPI's (72 hours). - Ensure high standard written correspondences in Arabic & English. - Fulfill Renewal book target. - Track all...
-
Commercial Contract Engineer Jed
2 days ago
الخبر, Saudi Arabia Schindler Full time**Location: Khobar, Khobar, Saudi Arabia** **Requisition ID: 78623** Schindler stands for mobility. Mobility needs experts. Join our team in Khobar. Founded in Switzerland in 1874, the Schindler Group is a leading global provider of elevators, escalators, and related services. Schindler mobility solutions move two billion people every day all over the...
-
Procurement Officer, Interior Fit-out
2 weeks ago
الخبر, Saudi Arabia Itineris Full time**This position is open to Lebanese Applicants with relevant experience, currently residing in Lebanon.** **Role Summary**: The Procurement Officer oversees procurement operations, ensuring the timely sourcing, purchasing, and delivery of quality materials at cost-effective rates. This role requires strong vendor management, negotiation skills, and...
-
Family Medicine
2 weeks ago
الخبر, Saudi Arabia Bupa Arabia Full timeFamily Medicine Senior Registrar will provide comprehensive primary healthcare physically and through telemedicine to individuals and families of all ages, encompassing preventive, acute, and chronic care. Will play a crucial role in diagnosing and treating a wide range of medical conditions, promoting health education and preventive measures, and...
-
Call Center Agent
2 weeks ago
الخبر, Saudi Arabia Allianz Partners Full timeSummary: The main duty of a Call Centre - Agent is to respond to telephone inquiries about the company's services following standard scripts and procedures. To ensure calls are answered within predetermined time scales and are dealt with properly. Documents details of telephone conversation and actions taken. The incumbent is also responsible to correspond...
-
Legal and Compliance Associate
6 days ago
الخبر, Saudi Arabia Hamad M. Al Rugaib & Sons Trading Co. Full time**Job Overview**: We are looking for a reliable and knowledgeable Legal Advisor to be a part of our company. You will be primarily responsible for providing legal assistance to the company when required. Besides, you should be able to conduct thorough research and perform in-depth analysis on legal matters. You should also be able to review and help prepare...
-
الخبر, Saudi Arabia SAS Global Consultants Full time**Location**: Khobar, Saudi Arabia **Salary**: SAR 45,000 per month **Benefits**: + Housing, Transport, Medical insurance & paid annual leave **Company**: Real Estate Developer **Job Summary**: Our client are seeking a highly skilled and experienced Project Controls Manager who should have at least 15-20 years of experience within project controls,...
-
Senior Project Manager
1 day ago
الخبر, Saudi Arabia WSP Full time**What if you could do the kind of work the world needs?** At WSP, you can access our global scale, contribute to landmark projects and connect with the brightest minds in your field to do the best work of your life. You can embrace your curiosity in a culture that celebrates new ideas and diverse perspectives. You can experience a world of opportunity and...
-
Field Service Engineer
3 days ago
الخبر, Saudi Arabia Philips Full time**Job Title**: Field Service Engineer - Graduate (Al Khobar) Job Posting Description **Don’t just learn to work - work to learn, surprise yourself with Philips!** **Location**:Al Khobar **Contract duration**:12 months **Job title**: As a** Field Service Engineer Graduate** you will get a chance to positively impact the Philips business in the Kingdom...
-
Business Line Manager
1 day ago
الخبر, Saudi Arabia Atlas Industrial Equipment Co Full time**Business Line Manager - Air and Gas Applications (AGA)**: - Functional area: Business Development - Country: Saudi Arabia - City: Khobar - Company name: Atlas Industrial Equipment Co - Date of posting: Jan 24, 2025 Our solutions are a key part of most industries - electronics, medical research, renewable energy, food production, infrastructure and many...
-
Administrative Officer
2 days ago
الخبر, Saudi Arabia شركة المرافق الأولى للمقاولات العامة Full timeJob Title: Administrative Officer 6 days per a week from 10:00 AM to 7:00 PM, during this time, there is an hour's break. - Location: KSA-Khobar - Saudi Only v **Responsibilities**: - Prospecting and generating sales leads through cold calling, networking, and digital marketing. - Develop plans to target customers and move forward to sign maintenance &...
-
General Service Operator
2 weeks ago
الخبر, Saudi Arabia Met T&S Full time**General Service Operator**: **Date**: - 07/03/2025 **Place of work**: - Saudi Arabia **Job Title**: - GENERAL SERVICES OPERATOR **Reference**: - 20090050 **Project** - Tecnimont Khobar Office **Job Location**: - Al Khobar, KSA **Job type/Contract**: - Contractual. Start on ASAP **Salary range**: - Competitive salary package with...