Manage and lead a team of claims specialists, providing guidance, mentorship, and support to ensure exceptional customer service and efficient claims processing. Oversee the end-to-end claims process, from initial claim submission to resolution, ensuring accuracy, compliance, and timely processing. Implement and maintain quality control measures to uphold the highest standards of claims handling Interact with policyholders, agents and other stakeholders to address claim related inquiries and concerns. Utilize claims data and analytics to identify trends, patterns and opportunities for process improvement. Ensure compliance with insurance regulations and company policies in all claims processing activities. Monitor and report on departmental performance metrics, including claims processing times, customer satisfaction and efficiency. Identify and implement process enhancements to streamline claims operations and enhance the customer experience. Provide training and development opportunities for team members to enhance their skills and knowledge.
Role & responsibilities Building and Managing positive relationships with the Hospitals. Researching and generating new business with the hospitals. Doing Empanelment of Hospitals. Help promote and maintain a positive company image. If required, he/she should accompany any VIP patient who is getting admitted to the hospital.
1. Government Liaison and Institutional Engagement: - Build and maintain strong professional relationships with the Ministry of Foreign Affairs (MOFA) and High Commissions. Serve as the primary point of contact for government stakeholders, ensuring alignment on service objectives and prompt resolution of issues. 2. Insurance Relationship Management: - Develop and maintain ongoing relationships with existing insurance companies, acting as a key account manager for service coordination, issue resolution, and strategic alignment. Work closely with insurance partners to understand evolving needs and ensure delivery of value-added services that strengthen the partnership. Schedule and conduct regular review meetings (both virtual and in-person) to present performance reports, discuss challenges, and explore new areas of cooperation. 3. Provider Network and Healthcare Partner Support Support the Provider Networking Team in the empanelment and on boarding of hospitals, clinics, and diagnostic centers across the GCC. Facilitate documentation, relationship-building, and on boarding activities for new providers, ensuring alignment with service quality standards and commercial terms. 4. Business Development and Client Acquisition Identify and target potential clients across government, corporate, and healthcare segments within the GCC region. Develop proposals, lead presentations, and conduct client pitches tailored to the specific needs of prospective partners. Maintain an active pipeline of business opportunities and provide regular updates to senior management on the status and conversion ratio. 5. Operational and Customer Support : - Assist the operations and customer service teams in addressing client and patient queries. Ensure timely resolution of service-related issues and act as an escalation point for complex cases requiring managerial intervention. Support service quality audits and participate in designing solutions to enhance client experience. 6. Client Engagement, Retention, and Service Excellence: - Actively engage with existing clients through scheduled virtual and physical meetings, relationship reviews, and service feedback sessions. Prepare and present detailed Management Information System (MIS) reports covering KPIs, claims data, service metrics, and operational insights. Provide tailored presentations to clients showcasing improvements, innovations, and outcomes aligned with client objectives. 7 . Reporting and Strategic Communication: - Maintain accurate and up-to-date records of all client communications, meeting outcomes, and follow-ups using CRM tools or designated platforms. Contribute to internal strategic planning sessions by sharing client feedback, market intelligence, and service improvement suggestion