HB Senior Claims Manager

6 days ago

Riyadh, Saudi Arabia WTW Full time
Description

The Role

  • Lead the claims team for his/her region in KSA responsible for employee benefits claims. This includes managing staff performance providing guidance and ensuring the department meets service level agreements and regulatory standards.
  • Oversee the claims process for H&B in his/her region in KSA ensuring that it follows the H&B operating model and claims are processed efficiently and fairly. This includes working with insurance carriers to expedite claims resolution and ensure compliance with policy terms. Ensure that clients are kept informed throughout the claims process.
  • Serve as the first escalation point for employers regarding claims issues. Work to resolve any client concerns and issues. Provide updates to clients until claims issues are resolved.
  • Serve as the main H&B claims consultant for employers. Provide expert advice on claimsrelated inquiries and work to resolve any client concerns. Ensure that clients are kept informed throughout the claims process.
  • Serve as the main point of contact for other departments within the H&B team regarding claims issues and ensure adherence to turnaround times stipulated by SLAs between H&B and clients.
  • Handle complex or escalated claims negotiating with insurers healthcare providers and legal teams when necessary. Work to resolve disputes or issues that may arise during the claims process. Provide insight on medical reports when needed.
  • Ensure that all claims handling complies with local regulations and other relevant laws.Stay updated on regulatory changes affecting employee benefits claims.
  • Provide regular reports to H&B Placement Team and H&B Client Management Team on claims performance identifying trends and making recommendations for improvement. This can also involve analyzing claims data to identify potential costsaving opportunities.
  • Work closely with the wider H&B team to provide insights on claims experience assist with renewal negotiations when needed and help tailor benefits packages based on claims trends.
  • Build and maintain relationships with insurers and thirdparty administrators (TPAs) to ensure efficient claims handling and resolution.Negotiate favorable terms where necessary.
  • Assist employers in understanding the claims process and their employees benefits providing training or materials to help them navigate the system effectively.
  • Continuously review and improve the H&B claims handling processes to enhance client satisfaction and operational efficiency. Explore innovative solutions such as digital claims handling or automated claims systems.


Qualifications

The Requirements

  • Bachelors Degree
  • Medical Degree is preferred
  • Min. 5 years working experience at similar role
  • Excellent proficiency in both English and Arabic
  • Proficiency in Microsoft Office (Excel Word PowerPoint).
  • Clientoriented innovative and critical sense
  • Problemsolving and solutionoriented
  • Good presentation and negotiation skill

Application Process

  • Stage 1: Online application and recruiter review
  • Stage 2: Interview with hiring manager and team
  • Stage 3: Offer and onboarding

Were committed to equal employment opportunity and provide application interview and workplace adjustments and accommodations to all applicants. If you foresee any barriers from the application process through to joining WTW please email

WTW is an equal opportunity employer



Required Experience:

Manager

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