Medical Claims Manager - Corporate Insurance

Position Summary

Corporate Claims Servicing & Advocacy

• Manage and oversee all corporate medical insurance claims support activities.
• Act as the primary escalation point for complex, delayed, disputed, or rejected claims.
• Represent clients' interests and advocate for fair claim settlements with insurers and TPAs.
• Facilitate resolution of reimbursement, pre-authorization, inpatient, outpatient, maternity, dental, optical, and chronic care claims.
• Ensure claims are managed within agreed service levels and client expectations.

Client Relationship Management

• Build and maintain strong relationships with corporate clients, HR teams, and key decision-makers.
• Conduct periodic claims review meetings with clients.
• Provide guidance on policy benefits, exclusions, network utilization, and claims procedures.
• Support Key Account Managers in enhancing client satisfaction and retention.
• Address client concerns and complaints relating to medical claims and service delivery.

Insurer & Tpa Relationship Management

• Liaise regularly with insurers, TPAs, hospitals, and healthcare providers to ensure smooth claims processing.
• Escalate unresolved cases to senior insurer and TPA stakeholders.
• Monitor insurer and TPA service performance against agreed SLAs.
• Participate in insurer review meetings to address recurring claims issues and service gaps.
• Develop strong working relationships with key insurer and TPA contacts.

Claims Analytics & Renewal Support

• Analyze claims utilization, claims ratios, chronic illness trends, and high-cost claims.
• Prepare claims experience reports for clients and management.
• Support Corporate Sales and Account Management teams during renewals and client presentations.
• Identify claims patterns and recommend cost-containment strategies.
• Provide insights to support renewal negotiations with insurers.

Team Leadership & Management

• Lead, mentor, and develop the Claims Team.
• Define team KPIs and monitor service performance.
• Conduct regular coaching sessions and performance reviews.
• Ensure adequate staffing, workload distribution, and operational efficiency.
• Foster a customer-centric and solution-oriented culture.

Operational Excellence

• Establish and maintain claims service standards and SOPs.
• Ensure proper documentation and tracking of claims cases.
• Implement automation and digital initiatives to improve claims servicing efficiency.
• Monitor turnaround times and continuously improve service delivery.
• Coordinate with internal departments to ensure seamless client servicing.

Compliance & Governance

• Ensure adherence to UAE insurance regulations and company policies.
• Maintain confidentiality and security of client medical information.
• Support internal audits and compliance reviews.
• Identify and report potential fraud, abuse, or misuse of insurance benefits.
• Pay: AED5,000.00 - AED8,000.00 per month