DB Claims Executive

4 days ago

Muscat, Muscat, Oman GIG Gulf Full time

DB Claims Executive - Healthcare **Omani National**

Who we are

GIG Gulf is part of the Gulf Insurance Group (GIG), the #1 largest regional composite insurer in the Middle East and North Africa, with presence in 13 markets including the United Arab Emirates, Bahrain, Oman, Qatar, Saudi Arabia, Algeria, Egypt, Iraq, Jordan, Kuwait, Lebanon, and Turkey. GIG Group reported consolidated assets of US$ 3.83 billion and $69 million net profit for the year 2023.

GIG Gulf is an 'A' rated regional insurer with a top 5 position in each of its markets (UAE, Oman, Qatar, Bahrain). GIG Gulf has been present in the region for over 70 years with a strategic focus on both growth and investments and is a one stop shop offering a wide range of insurance products and services that cater to a broad variety of needs for corporates, SMEs and individual customers throughout UAE, Oman, Bahrain, and Qatar.

Job purpose:

Contribute to the team and departmental productivity targets, ensuring the smooth and efficient processing of claims, and maintaining compliance with regulations and policies. Respond to providers/departments communications in a timely and accurate manner in accordance with Claims management and member policies while ensuring efficiency & accuracy through applying proper clinical & processing guidelines.

Key Responsibilities

  1. Team Management: Handle TL responsibilities in his/her absence by overseeing and managing the team in both claims processing and communication. Provide guidance, direction, and support to the team members, monitoring their performance, ensuring that the team meets their goals and targets.
  2. Claims Processing: Involved in the processing of direct billing claims according to the department requirements. Review complex or high-value claims, taking decisions on claims settlements, and resolving any issues or disputes that arise during the claims process.
  3. Communications: Involved in communication with providers and other departments through emails and phone calls, including claims registration, escalations, and handling provider queries.
  4. Training and Development: Involved in the training of new team members and providing ongoing training to existing staff, preparing training materials, and providing feedback and coaching.
  5. Performance Monitoring: Responsible for tracking and monitoring the performance of the direct billing claims team, providing feedback to team members, and identifying areas for improvement.
  6. Process Improvement: Identify opportunities to streamline processes, enhance efficiency, and reduce errors or delays in claim processing.
  7. Reporting and Analysis: Prepare reports and analyze data related to the team's performance and claim trends, providing regular updates to their line TL/Manager.
  8. Compliance and Quality Assurance: Ensure compliance with all applicable laws, regulations, and industry standards, conducting quality assurance audits and internal reviews.

Operational & Technical Responsibilities

  1. Oversee the claims processing workflow, coordinating the workflow within the direct billing claims department.
  2. Ensure the accuracy and quality of claims processing within the team, conducting regular audits and quality checks.
  3. Have a strong understanding of the technical aspects of direct billing claims processing.
  4. Evaluate claims based on policy terms and conditions, medical necessity, and coding guidelines.
  5. Report potentially fraudulent or suspicious claims and collaborate with relevant departments.
  6. Maintain accurate and up-to-date information on contracted healthcare providers.
  7. Assist in the evaluation and review of claims rejections.
  8. Ensure proper replies to email communications in a professional and timely manner.
  9. Possess good communication skills, both written and verbal.

Role Requirements

Essential:

  1. Due to regulatory requirements, ONLY Omani nationals will be considered for this role.
  2. Medical education degree is required (Physician or Dental).
  3. Very good communication skills.
  4. Excellent command of English language.

Desirable:

  1. 2-3 years of experience in Claims processing, Employee benefits/ Healthcare and / Group Life.
#J-18808-Ljbffr

  • MENA Regional Sales Executive

    20 hours ago

    Muscat, Muscat, Oman DB Investing Full time

    About DB InvestingDB Investing is a leading financial services provider offering a range of products and services to individuals and institutions in the MENA region.Job DescriptionThis role offers a unique opportunity for a sales professional to develop and maintain relationships with clients in the MENA/GCC market. Key responsibilities include:Developing...

  • Forex IB Introducing Broker for Oman

    22 hours ago

    Muscat, Muscat, Oman DB Investing Full time

    Forex Introducing Broker for MENA at DB InvestingWe seek a dynamic and motivated individual to join our Sales department as an Introducing Broker for MENA at DB Investing. In this role, you will develop and maintain relationships with clients in the MENA/GCC market.Key responsibilities include:Identifying and engaging with potential clients in the MENA...

  • International Trade Broker for Oman

    20 hours ago

    Muscat, Muscat, Oman DB Investing Full time

    Job OverviewThis is an exciting opportunity for a sales professional to join our team as an Introducing Broker for the MENA region at DB Investing.Key ResponsibilitiesThe successful candidate will be responsible for:Developing and maintaining relationships with clients in the MENA/GCC marketProviding tailored investment advice and solutions to meet clients'...

  • Middle East Financial Markets Representative

    20 hours ago

    Muscat, Muscat, Oman DB Investing Full time

    DB Investing is seeking a skilled sales professional to join our team as an Introducing Broker for the MENA region.About the RoleThe successful candidate will be responsible for developing and maintaining relationships with clients in the MENA/GCC market. This includes:Identifying and engaging with potential clients in the MENA regionProviding expert...

  • Forex Market Development Specialist

    20 hours ago

    Muscat, Muscat, Oman DB Investing Full time

    We are seeking a highly motivated and experienced sales professional to join our team as an Introducing Broker for the Middle East and North Africa (MENA) region at DB Investing.Job DescriptionThe successful candidate will be responsible for developing and maintaining relationships with clients in the MENA/GCC market. Key responsibilities include:Identifying...

  • Sales Executive

    7 days ago

    Muscat, Muscat, Oman Diligent Business Solutions LLC Full time

    Company DescriptionDiligent Business Solutions LLC (DBS LLC) is a dynamic company offering specialized services through its three divisions: Diligent IT Solutions, Diligent Interior Fit-Out Solutions, and Pro Scrap. We deliver high-end interior fit-outs for commercial spaces with precision and creativity. In addition to our interior services, we provide...

  • Sales Executive

    4 days ago

    Muscat, Muscat, Oman Diligent Business Solutions LLC Full time

    Get AI-powered advice on this job and more exclusive features.Diligent Business Solutions LLC (DBS LLC) is a dynamic company offering specialized services through its three divisions: Diligent IT Solutions, Diligent Interior Fit-Out Solutions, and Pro Scrap. We deliver high-end interior fit-outs for commercial spaces with precision and creativity. In...

  • Forex IB Introducing Broker for Oman

    4 days ago

    Muscat, Muscat, Oman Job Solutions Full time

    We seek a dynamic and motivated individual to join our Sales department as an Introducing Broker for MENA at DB Investing. In this role, you will develop and maintain relationships with clients in the MENA/GCC market.Key Responsibilities:Identifying and engaging with potential clients in the MENA regionProviding investment advice and solutions tailored to...

  • Fraud Analyst

    4 days ago

    Muscat, Muscat, Oman Nextcare Full time

    The Fraud Analyst role plays a key part in our global claims cost containment strategy. The ideal candidate will have an inquisitive mind and be focused on ensuring we prevent fraudulent activity/waste and abuse at all stages of the claim journey.The role requires the ability to multitask across numerous disciplines within the global claims department and is...

  • Senior Planning Engineer

    10 hours ago

    Muscat, Muscat, Oman Turner & Townsend International Limited Full time

    We currently have an opportunity for a Senior Planning Engineer in Oman who will be responsible for:Key Duties:Function as a main advisory to the Project Managers / Director in all issues concerning planning scheduling and resources needed. Deals with progress management – delays corrective actions and claims.Identify the content of the weekly / monthly...

  • Strategic Planning Consultant

    4 hours ago

    Muscat, Muscat, Oman Turner & Townsend International Limited Full time

    At Turner & Townsend International Limited, we are seeking a highly skilled Senior Planning Engineer to join our team.Key Responsibilities:Provide expert planning advice to project managers and directors on scheduling, resource allocation, and progress management.Develop weekly and monthly progress reports tailored to client requirements.Support the claims...

  • Procurement and Supply Chain Expert

    20 hours ago

    Muscat, Muscat, Oman Petroluem Development Oman Full time

    About Petroleum Development OmanWe are a leading exploration and production company in the Sultanate of Oman. Our mission is to deliver the majority of the country's crude oil production and natural gas supply.Job DescriptionAs a Senior Pre and Post Award Contract Excellence Specialist, you will be responsible for improving and ensuring effectiveness and...

  • Project Operations Manager

    1 day ago

    Muscat, Muscat, Oman ABB Full time

    Project Operations ManagerAt ABB, we are dedicated to addressing global challenges. Our core values: care, courage, curiosity, and collaboration - combined with a focus on diversity, inclusion, and equal opportunities - are key drivers in our aim to empower everyone to create sustainable solutions.That's our story. Make it your story.This position reports...

  • Assistant Manager

    3 days ago

    Muscat, Muscat, Oman MedNet Global Healthcare Solutions LLC Full time

    Assistant Manager- Operations - for MNSPCAs a member of Munich Re, the MNSPC is one of the leading managed care service organizations that caters to healthcare needs. We are currently looking to hire an "Assistant Manager - Operations." The job holder will be responsible for supporting the Operations Manager in achieving company business targets by...

  • Senior Commercial Manager

    2 days ago

    Muscat, Muscat, Oman ENGINEERINGUK Full time

    You will need to login before you can apply for a job.Senior Commercial Manager (Sports Stadium)Sector: Sales and Business DevelopmentRole: Senior ExecutiveContract Type: PermanentHours: Full TimePosition status: This opportunity is for a secured role that is due to commence in March subject to approval. If you would like to be considered as we progress with...

  • ISC Pre and Post Award Process Specialist

    22 hours ago

    Muscat, Muscat, Oman Petroluem Development Oman Full time

    ISC Pre and Post Award Process Specialist (Four Years Contract)Job Id: PDO2119Start Date: Feb 04, 2025End Date: Feb 13, 2025Company Name: Petroleum Development OmanNo of Positions: 2Position Type: TemporaryJob Type: Not SpecifiedNationality Required: Not SpecifiedAbout the CompanyPetroleum Development Oman is the leading exploration and production company in...

  • Senior Commercial Manager

    5 days ago

    Muscat, Muscat, Oman Mace Group Full time

    Position status: This opportunity is for a secured role that is due to commence in March subject to approval. If you would like to be considered as we progress with this position, please click to apply.At Mace, our purpose is to redefine the boundaries of ambition. We believe in creating places that are responsible, bringing transformative impact to our...

  • Contract Administrator

    3 days ago

    Muscat, Muscat, Oman Mace Full time

    At Mace, our purpose is to redefine the boundaries of ambition. We believe in creating places that are responsible, bringing transformative impact to our people, communities, and societies across the globe. To learn more about our purpose, culture, and priorities, visit our strategy site.Within our consult business, we harness our unique combination of...