Senior Employee Benefits Specialist
1 week ago
The Senior Employee Benefits Specialist will be responsible for leading the employee benefits claims team in a region in Saudi Arabia. The key responsibilities include:
- Managing staff performance, providing guidance, and ensuring the department meets service level agreements and regulatory standards.
- Overseeing the claims process for employee benefits in a region in Saudi Arabia, ensuring that it follows the company's operating model, and claims are processed efficiently and fairly.
- Serving as the first escalation point for employers regarding claims issues. Working to resolve any client concerns and issues. Providing updates to clients until claims issues are resolved.
- Serving as the main employee benefits claims consultant for employers. Providing expert advice on claims-related inquiries and working to resolve any client concerns. Ensuring that clients are kept informed throughout the claims process.
- Serving as the main point of contact for other departments within the company regarding claims issues, and ensuring adherence to turnaround times stipulated by SLAs between the company and clients.
- Handling complex or escalated claims, negotiating with insurers, healthcare providers, and legal teams when necessary. Working to resolve disputes or issues that may arise during the claims process. Providing insight on medical reports when needed.
- Ensuring that all claims handling conforms to local regulations and other applicable laws. Staying informed about regulatory changes impacting employee benefits claims.
- Supplying regular reports to the Placement Team and Client Management Team on claims performance, highlighting trends and suggesting improvements. This may involve analyzing claims data to identify potential cost savings.
- Collaborating with the broader team to provide insights on claims experience, supporting renewal negotiations when necessary, and aiding in tailoring benefits packages based on claims trends.
- Maintaining strong relationships with insurers and third-party administrators (TPAs) to ensure efficient claims handling and resolution. Negotiating favorable terms when required.
- Aiding employers in understanding the claims process and their employees' benefits, providing training or materials to facilitate effective navigation of the system.
- Consistently evaluating and enhancing the employee benefits claims handling processes to boost client satisfaction and operational efficiency. Investigating innovative solutions like digital claims handling or automated claims systems.
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