Employment:
Full Time
Job Description
Job Title: Quality Assurance Executive – Medical Operations
Reporting to: Head of Operations Support & Quality Assurance
Tasks & Responsibilities
• Develop & maintain quality standard for Medical Claims Department
• Review claims and approvals processed by a processor and system
• Create tools and strategies for process/quality improvement
• Generates dashboard reflecting performance of Medical Claims Department
• Reporting gaps or training needs of agents to department manager
• Maintain and record all identified gaps
• Monitor corrective measures and action plan from department manager
• Offer support to other team members within the department
Professional/Educational Qualification
• Medical background is a MUST
Requirements
• With claims processing experience of more than 2 years
• May be a nurse or a doctor
• With medical coding experience (license is not a must)
• Experience in third party administration is preferred but not a must
• Preference will be given to the candidate with experience in similar role
• Strong communication skills including ability to communicate negative feedback
• A good track record of analytical skills
• Good organization skills and time management skills
• Proficiency in data presentation and analysis
• Problem solving capabilities
• Strong sense of professional integrity
• Highly rational with an appreciation of practical and common-sense solutions
One of the leading “TPA” , Third Party Administrators in Medical Insurance ; a subsidiary of a fortune 20 Multi National Company , with extensive operation across GCC prospering over the last 18 years in facilitating our customers beyond their expectations in all services on par with global standards.
We are committed in ensuring to provide high quality , superior, innovative and cost-effective business solutions in the areas of healthcare and insurance services and embrace the good will of being one among the best leading TPA’s in this region serving over 50 insurance companies , in administering their multiple policies as well as catering to self-funded schemes with both international and local policies amidst our stake holders.
It is significant to share our accolades, that we serve more than 1.4 million members whilst administering over AED 4 billion worth of claims annually through a dedicated team of 700 + medical professionals in our talent pool from different parts of the world. We are partnered with a broad global network of over 4,000 health care providers in the region and always thrive to delight our customer through every service we provide remarkably.
We believe in attracting dynamic , focused , self-motivated , professionals with industry expertise to join hands with us to move forward in a journey, which promises growth and career establishment as per each one’s skills and potential.
Source: Job Posting - gulftalent.com
