Specialist- Insurance Claims

1.Participate in the development and implementation of a system for managing insurance claims, including E-claims in the emirate, for submitting and approving insurance claims in accordance with the health insurance policies, legislation, and approved local and federal laws.
2.Participate in the development and implementation of policies, procedures and guidelines to effectively manage insurance claims in the emirate.
3.Ensure that all parts of the health insurance system adhere to the policies, standards and terms governing the process of submitting and approving health insurance claims in the emirate.
4.Ensure that insurance claim data furnished by the service providers are comprehensive, clear and compatible with the health data exchange system (NABED) and other systems.
5.Participate in the development of national health insurance services that ensure the effectiveness and efficiency of the insurance claims management system in cooperation with the relevant organizational units and concerned authorities.
6.Participate in the establishment of a robust system to ensure authenticity/validity of insurance claims submitted by health service providers and claims management agencies.
7.Take timely and appropriate action on the wrong or fraudulent claims, including recovery of the wrongful claims and censuring the concerned parties.
8.Resolve any dispute between the parties like service providers and insurance agencies or beneficiaries in a timely and amicable manner and escalate major issues to the higher management.
9.Provide timely and valuable feedback on the online portal for health insurance claims management system to make it more user friendly and effective.
10.Represent the department in meetings and discussions with regulatory authorities and other relevant stakeholders.
11.Stay abreast of the latest development and trends in the insurance claim management system and adopt the same within the emirate.
12.Guide and educate other staff on the insurance claim management system.
13.Perform any other related duties as assigned.

Qualifications

Minimum Qualification: Masters of Actuarial Science, Business Management or equivalent

Minimum Experience: 8 years in related field