Job Description

1. JOB PURPOSE: THE MANAGER- IP IS RESPONSIBLE FOR THE SUPERVISING A TEAM RESPONSIBLE FOR STRATEGIC AUTHORIZATION, PROCESSING & PAYMENT OF MEDICAL CLAIMS. PROVIDES GUIDANCE TO SUBORDINATES ON THE MOST COMPLEX IP CLAIMS. ASSISTS IN DIRECTING & OVERSEEING THE WHOLE OPERATIONS OF AN INSURANCE CLAIMS DEPARTMENT TO MEET OPERATIONAL, FINANCIAL, AND SERVICE REQUIREMENTS. PROVIDES GUIDANCE AND SETS POLICIES ON INSURANCE CLAIMS BASED ON COVERAGE. 2. RESPONSIBILITIES AND DUTIES - Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the operations - Deep knowledge of the managed care sub-function such as IP, Dental, Pharmacy and other claims - Abreast of any changes to legislation and regulations pertaining to insurance claims [Eg. DoH, DHA, Coding & DRG...etc. as per UAE standards] - Knowledge of GCC adjudication rules - Assess and issue authorization for inpatient claims both medically and policy wise - To verify that the treatment proposed / requested for is justifiable medically - To issue approvals for applicable treatment through an advanced software - Responding to critical cases and escalated phone calls from Beneficiaries, providers and insurance companies - Meeting and responding to correspondences and clarifying issues/ queries from Insurance companies (Inpatient Claims) - Monitor case management and follow up of high-cost surgeries (and admissions) through communicating with Payers and Providers - Respond to correspondence from international assistance partners - Assist in the induction and supervision of newly recruited Medical officers - Reporting periodically on department's activities; Manages backlogs and reports any suspected fraud cases to the auditing department - Represent the organization at DHA and DoH when requested - Lead, train, assess a direct team of claims officers and supervisors - Other duties as may be assigned 3. KNOWLEDGE, SKILLS AND EXPERIENCE

• Medical Doctor (MBBS degree holder); further post-graduate studies are a plus

• 3 years' practical experience in the healthcare industry / hospital setup preferably gained within an emergency department or surgery

• Good industry knowledge (healthcare & insurance sectors)

• Strong acumen for customer service

• Excellent in oral and written communication skills

• Must be computer literate

• Excellent command of the English language, Arabic & Hindi are a plus

• Candidate must be tactful and discrete when dealing with clients and must be able to handle confidential Information; escalate cases that are sensitive and of high-cost

• Ability to work under pressure

• Excellent knowledge of MS office, N'touch software and capabilities; ability to produce regular reports related to activities and cases.

• Good interpersonal and people management skills

Job Types: Full-time, Permanent Pay: AED15,000.00 - AED20,000.00 per month Ability to commute/relocate:

• Dubai: Reliably commute or planning to relocate before starting work (Required)

Education:

• Bachelor's (Preferred)

Experience:

• healthcare industry / hospital setup: 3 years (Preferred)
• insurance TPA: 3 years (Preferred)