Job Details

Career Coordinate

Job Title

Medical Claims & Healthcare Providers Manager










To Be Discussed


Main Tasks Network Management • Creation of an appropriate panel of medical providers within the company's area of operation (Middle East). • Management of medical service providers, including negotiation and implementation of standard contractual terms and conditions, up to signing of agreements. The emphasis will be upon delivering competitive volume pricing, procedure pricing, package pricing, fixed discounts expressed as a percentage of the final bill etc. • Provision of appropriate training, documentation and support to panel members. • Recording and maintenance of all medical provider details in the region onto the Provider database. Such entries to include the following: • Completion of appropriate financial arrangements with providers including, the management of claims costs. • Provide “on demand” information on medical service providers to internal departments as required, and having this information updated and available through the provider database. • Contribute towards the development of a system for measuring service provider’s performance, both in terms of quality of service as well as in cost efficiency. Superior Service Delivery • Commitment and delivery of the Company’s service standards, including a 24 hours turnaround for all claims and other written communication and a target call abandon rate of 2%. • Promote high Customer Service and Quality ethos on the team and in the company as appropriate. Help Line • The management of an in-house 24/7 helpline, providing phone, fax and email service to insured members in Arabic, English and French. Claims • Management of full claims adjudication, processing and payment function communicating with clients, distributors and providers as required. People Management • Including all HR related issues, as well as performance management and development. • Work monitoring, coaching and feedback Behaviour/Values • Customer Focused • Strong communication (verbal & written) and interpersonal skills • Strong negotiation skills • Ability to work effectively within a team environment • Honesty & integrity • Ability to work well under pressure • Ability to work on own initiative • Highly motivated & proactive • Results driven & solution oriented • Ability to prioritise workload and manage time effectively • Excellent leadership qualities & ability to delegate effectively • Ability to motivate others

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