DB Claims Executive

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.