Job Description

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 & Duties
Wellness 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 Duties
Primary

• 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 & Competencies
Technical 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.

Skills Required