Job Description

Pay:

2,500.00 (AED)-4,000.00 (AED) per month

:

Job Purpose

To support the design, coordination, and execution of wellness initiatives for corporate clients, while also managing the end-to-end processing and support of health insurance claims. This dual-function role ensures seamless service delivery in both wellness and claims, aligned with UAE insurance regulations and client expectations.

Key Responsibilities & DutiesWellness Program Support

Assist in the design and coordination of wellness programs tailored to client needs.

Facilitate wellness sessions including health screenings, fitness events, mental health workshops, and awareness campaigns.

Maintain wellness calendars and manage the execution of scheduled events.

Client & Stakeholder Engagement

Serve as the primary liaison between client HR teams, wellness service providers, and TPAs.

Provide regular updates to clients on wellness engagement levels and claims performance.

Address inquiries and escalate complex matters to relevant internal teams.

Wellness Monitoring & Reporting

Track wellness program participation rates and compile performance reports.

Analyze program effectiveness using KPIs and employee feedback.

Support the preparation of dashboards and reports for client presentations.

Claims Handling & Adjudication Support

Review claim submissions to ensure accuracy, completeness, and adherence to policy terms.

Coordinate with TPAs and internal claims units for timely approvals, rejections, and clarifications.

Support pre-authorization requests and follow up with healthcare providers for required documentation.

Claims Dispute & Resolution

Investigate claim rejections and support the appeals process where applicable.

Resolve client and employee concerns regarding delayed or denied claims.

Escalate unresolved disputes to the Claims Supervisor or insurer.

Benefit Verification & Policy Support

Verify coverage eligibility and benefit limits before processing high-value or complex claims.

Educate client HR teams on policy inclusions, exclusions, and claims processes.

Vendor & Provider Coordination

Schedule and manage services with external wellness vendors and healthcare providers.

Foster strong working relationships with TPAs and clinics to ensure smooth claims processing and wellness delivery.

Monitor service levels and turnaround times (TATs), raising concerns as needed.

Communication & Awareness

Develop and distribute wellness and claims communication materials (e.g., posters, emails, FAQs).

Promote employee awareness of wellness benefits and claims filing procedures through campaigns.

Maintain wellness and claims documentation for internal and external communication.

Training & Knowledge Building

Organize training sessions for employees and HR teams on wellness tools and insurance claim filing.

Stay updated on industry trends, wellness innovations, and UAE insurance regulations.

Contribute new ideas to improve employee engagement and claims efficiency.

Compliance & Audit Support

Ensure compliance with DHA/HAAD regulations and internal claims and wellness procedures.

Maintain accurate records of claims and wellness activities for audits.

Assist in preparing compliance reports and responding to audit queries.

Daily DutiesPrimary

Coordinate logistics for wellness activities and health events.

Review and follow up on claim submissions and approvals.

Maintain dashboards and reports for both wellness and claims performance.

Handle basic client queries related to wellness and claims.

Secondary

Create wellness content for newsletters and internal platforms.

Support onboarding of new clients in wellness and claims-related areas.

Participate in internal team initiatives aligned with HR and employee benefits.

Required Skills & CompetenciesTechnical Skills

Knowledge of wellness program planning and insurance claims processing.

Familiarity with UAE healthcare regulations (DHA/HAAD).

Proficiency in Microsoft Office Suite (Excel, PowerPoint, Outlook).

Experience with TPA portals or claims platforms (preferred).

Soft Skills

Excellent communication and interpersonal skills.

Strong time management and coordination abilities.

Analytical mindset with attention to detail.

Core Competencies

Teamwork: Collaborate with internal departments, TPAs, and clients effectively.

Customer Focus: Deliver prompt and supportive responses to client wellness and claims needs.

Problem Solving: Proactively address client issues and suggest improvements.

Adaptability: Adjust to evolving client requirements and regulatory updates.

Educational QualificationsEssential

Bachelor's degree in Healthcare, Insurance, Human Resources, or a related field.

Preferred

Certification in Health & Wellness, Insurance Claims Management, or similar.

Training in Mental Health Awareness, Wellness Coaching, or Employee Engagement.

CII, LOMA, or other insurance certifications (advantageous).

Knowledge Requirements

Familiarity with corporate wellness strategies and mental health initiatives.

Understanding of UAE health insurance practices, claims procedures, and compliance norms.

Awareness of wellness ROI measurement and employee engagement techniques.

Job Type: Full-time

Job Type: Full-time

Pay: AED2,500.00 - AED4,000.00 per month