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    Claim Officer – Nurse / Pharmacist | A Leading TPA (Third Party Administrator) in Medical Insurance

    Employment:

    Full Time

    Job responsibilities:• To issue online and verbal authorizations based upon member coverage & medical justification.• To assist queries from providers and payers via phone calls or e-mails• To maintain files for authorizations and other reports.• Assessing and processing claims in line with the policy coverage and medical necessity.• Be fully versed with medical insurance policies for various groups / beneficiaries.• Able to accurately assess eligibility within the UAE (HAAD and DHA) guidelines as well as policy boundaries.• Monitoring and maintaining the claims processing and adjudicating cycle in operational software system as per the defined terms and policy of the organization. • Establishing strategies and implementing effective parameters for solving all possible queries within the team.• Taking a lead role in assuring that the assigned tasks to the team are completed within the allocated time frame.• Ensures the proper communication and implementation of new formats, training and processing rules.• Entering and processing/ adjudicating claims in operational software system as per the terms and policy of the organization.

    Candidate’s Qualification:• University degree in any discipline of Medical/Para-medical specialization from a reputable university.• Healthcare/Hospital experience for 1-2 years, in departments such as Surgery, ICU or GP, is required.• 1 – 2 years of work experience in the Insurance industry is preferable but not mandatory.• Excellent oral and written communication skills.• Must be computer literate.• Excellent command of the English language, Arabic is a definite plus.• Should be a team player with an aptitude for customer service. Must be service oriented.• Highly decisive with outstanding logic and reasoning skills.• Candidate must be tactful and discrete while dealing with Providers or Payers; must be able to handle confidential information.• Ability to work under pressure and meet tight deadlines and varying work-schedules.

    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. More

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    Quality Auditor – Quality Assurance Executive – Medical Operations | A Leading TPA (Third Party Administrator) in Medical Insurance

    Employment:

    Full Time

    Job DescriptionJob Title: Quality Assurance Executive – Medical OperationsReporting to: Head of Operations Support & Quality AssuranceTasks & 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 MUSTRequirements• 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. More

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    Tax & Legal Services – Biostatistician (Healthcare) | PricewaterhouseCoopers

    Employment:

    Full Time

    Tax & Legal Services – Tax – Accounting & Payroll – Biostatistician (Healthcare) – DohaLine of ServiceTaxSpecialismOperationsManagement LevelManagerJob Description & SummaryA career in our Tax Accounting practice, within Tax services, will provide you with the opportunity to help our clients. You’ll advise clients while acting as a strategic consultant related to business analysis.Our team provides our clients advice based on their niche and business need.To really stand out and make us fit for the future in a constantly changing world, each and every one of us at PwC needs to be a purpose-led and values-driven leader at every level. To help us achieve this we have the PwC Professional; our global leadership development framework. It gives us a single set of expectations across our lines, geographies and career paths, and provides transparency on the skills we need as individuals to be successful and progress in our careers, now and in the future.You’ll work as part of a team of problem solvers, helping to solve complex business issues from strategy to execution. PwC Professional skills and responsibilities for this management level include but are not limited to:•  Should have minimum experience of 8-10 years, and are experts in setting KPIs, drawing strategy maps, data analysis, risk evaluation and management, dash boards productions, health intelligence, performance measures, and monitoring and evaluation.•  Selected candidate for Biostatistician shall provide assistance in data management in Healthcare Quality and Patient Safety. •  He/she will be responsible for accurately assessing encoding, and analyzing and transmitting data within the department or elsewhere.Tasks, Duties & Responsibilities:•  Administers the data received by the Department through its different managers; • Performs confidential data acquisition activities.• Collects, organizes and analyses statistical data related to Healthcare Quality and Patient safety.• Assists in managing health information according to standard policies and procedures.• Assists in developing annual reports within the department.• Helps in data management and dissemination.• Manages database, entering, manipulating, and maintaining data.• Ensures the generation of correct information that follows confidentiality guidelines.• Supports the delivery of projects/reports accordingly to meet deadlines.• Performs activities requiring the integration of multiple office technologies and software applications.• Performs tasks and activities as assigned.

    Key Performance Indicators:•  Successful completion of projects within the timelines as prescribed by the higher authorities.Job Requirements (Knowledge, Skills and Experience Required):•  Formal Education Requirement Relevant Healthcare Professional Qualification, Master’s degree required in the relevant field.Experience Requirements:•  Minimum of 8 years of experience in the relevant field.Technical Skills requirement:• Experience in Monitoring and Evaluating Quality Improvement Projects• Understanding and experience in quality management within a healthcare setting• Understanding of the health care system and patient care approaches such as multidisciplinary care, coordination of care and care standards and protocolsPersonality Traits:• Ability to work autonomously, meet deadlines and take responsibility for achieving outcomes• Well-developed leadership skills to meet organisational goals and objectives• Strong administrative and organisational skills• Excellent written and verbal communication skills for a range of audiences• Excellent computer skills including excel and databases• Excellent time management – able to prioritise effectively to meet multiple ongoing deadlines

    PwC firms help organizations and individuals to create the value they’re looking for.

    We’re a network of firms in 158 countries with close to 169,000 people who are committed to delivering quality in assurance, tax and advisory services. PwC is the brand under which member firms of PricewaterhouseCoopers International Limited (PwCIL) operate and provide services. Together, these firms form the global PwC network.

    In our 3 key areas of business or Lines of Service Assurance, Tax, and Advisory we work with our clients from business start ups to the worlds leading organizations to measure, protect and enhance the things that matter most to them.

    We help our own people to learn, discover, develop and make a real difference all the way through their working lives. And we have big ambitions to grow.

    PwC Middle East Region is part of what we call the Central Cluster and includes the UK, Europe and Africa as well as the Middle East. The region consists of 12 markets – UAE, Saudi Arabia, Qatar, Kuwait, Bahrain, Oman, Jordan, Lebanon, Egypt, Libya, Iraq and Palestine.

    PwC has been established in the region for over 40 years, we already employ over 4500 people and we are on course to become the Middle East number one professional service firm. More

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    Tax & Legal Services – Healthcare Facility Planning | PricewaterhouseCoopers

    Employment:

    Full Time

    Tax & Legal Services – Tax – Accounting & Payroll – Healthcare Facility Planning – DohaLine of ServiceTaxSpecialismOperationsManagement LevelSenior ManagerJob Description & SummaryA career in our Tax Accounting practice, within Tax services, will provide you with the opportunity to help our clients. You’ll advise clients while acting as a strategic consultant related to business analysis.Our team provides our clients advice based on their niche and business need.To really stand out and make us fit for the future in a constantly changing world, each and every one of us at PwC needs to be a purpose-led and values-driven leader at every level. To help us achieve this we have the PwC Professional; our global leadership development framework. It gives us a single set of expectations across our lines, geographies and career paths, and provides transparency on the skills we need as individuals to be successful and progress in our careers, now and in the future.You’ll work as part of a team of problem solvers, helping to solve complex business issues from strategy to execution. PwC Professional skills and responsibilities for this management level include but are not limited to:- Should have minimum working experience of 15 years, in healthcare policies, health performance measures and quality and patient’s safety.- The Senior Specialist, healthcare facility services planning shall be responsible for coordinating health services programs, resource development and research and planning practices in order to implement programs and develop standards; and to perform related work as required.- Under general direction, incumbents are responsible for coordinating multidisciplinary staff efforts, and directing the work of a health division in the use of integrated research and planning, and program and resource development.- The Senior Specialist, healthcare facility services planning represents the Healthcare Facility Planning Unit in planning and evaluation matters before MOPH departments, community, governmental, and professional groups.Nature and Scope of Position:- Develops and implements research and planning activities to maintain an integrated approach to health care development and resource allocation.- Directs studies and analysis of health care efficiency, access, appropriateness, and effectiveness.- Coordinates departmental activities related to health services programs.- Proposes health care policies and monitors implementation of such policies.- Identifies health care financial resources and directs the writing of grant proposals for such resources.- Participates in professional committees directed toward priority health care areas.- May supervise the work of professional and clerical staff.- Provides responsive, high quality service to employees, representatives of outside agencies and members of the public by providing accurate, complete and up-to-date information, in a courteous, efficient and timely manner.- Responsible for directing and coordinating all aspects of the service planning of the healthcare facility development process from project business planning through to health service operation.- Responsible for Developing and implementing of the systems, processes and resources required to deliver the service planning aspect of the healthcare facility development program- Determines and updates Qatar the service planning aspects of the healthcare facility existing master plan.- Directing and coordinating all service planning aspects of developing and updating Qatar Health Care Facility Master Plan process from project business planning through to operation.- Develops and implement meeting and reporting structures and cost reporting systems- Coordinates the development and implementation of all necessary information to support the production of the service planning aspects of healthcare facility business cases for new developments.- Works with health care providers on the service planning aspects of the business case, ensuring a range of health service options- Supports the Manager of healthcare facility planning unit with the day-to-day management and coordination of specific healthcare facility projects to the approved scope, time, quality and cost parameters- Prepares monthly progress reports, the coordination and flow of relevant information to stakeholders, the preparation of consultant briefs and the development of a detailed project program- Performs miscellaneous duties as assigned

    Experience Required:- Principles of healthcare systems and program planning- Collection, management, and analysis of health services data- Health, Safety, Welfare major legislation related to these areas- Fiscal management and budgeting including principles and practices of health services cost analyses and cost containment strategies- Principles and practices of personnel management, supervision, employee relations, and training- Purposes, goals, and responsibilities of health, public assistance, protective services, and social services programs as they relate to health services priority areas- Analyze and evaluate a variety of complex health care problems and recommend practical solutionsSkill Requirements:- Leadership, Team Builder, Communicates Effectively, Knowledge Worker, Decision Maker, Strategic Perspective, Leverages Resources (Coaches and Develops), Demonstrates Ethical Behavior, Maximizes Team Effectiveness, Supportive of Change- Analyze, develop, and recommend changes in methods, systems, policies, and procedures to the highest levels of management on complex and sensitive issues- Communicate effectively orally and in writing with professional, administrative and legislative representatives- Communicate effectively with a variety of individuals representing diverse cultures and backgrounds and function calmly in situations which require a high degree of sensitivity, tact and diplomacy- Plan, organize, and coordinate the work of ad-hoc multidisciplinary planning groups and supervise graduate students- Organize and direct group discussions- Plan, coordinate, and initiate actions and implement decisions and recommendations- Read and comprehend complex material often involving legal, technical, or medical matters- Prepare and present concise, logical oral and written reports- Explain policy, procedures, and recommendations on a wide variety of medical issues- Establish effective working relationships with management, employees, employee representatives and the public representing diverse cultures and backgrounds- Treat employees, representatives of outside agencies and members of the public with courtesy and respect- Exercise appropriate judgment in answering questions and releasing information; analyze and project consequences of decisions and/or recommendations- Strong interpersonal and communication skills and the ability to work effectively with a wide range of colleagues in a diverse community (essential);- Ability to gain confidence of very senior managers and clinicians (essential);- Knowledge of organizational structures, workflow, and operating procedures (essential);- Excellent presentational skills (essential); Word processing, Outlook, Excel and internet applications (essential)

    PwC firms help organizations and individuals to create the value they’re looking for.

    We’re a network of firms in 158 countries with close to 169,000 people who are committed to delivering quality in assurance, tax and advisory services. PwC is the brand under which member firms of PricewaterhouseCoopers International Limited (PwCIL) operate and provide services. Together, these firms form the global PwC network.

    In our 3 key areas of business or Lines of Service Assurance, Tax, and Advisory we work with our clients from business start ups to the worlds leading organizations to measure, protect and enhance the things that matter most to them.

    We help our own people to learn, discover, develop and make a real difference all the way through their working lives. And we have big ambitions to grow.

    PwC Middle East Region is part of what we call the Central Cluster and includes the UK, Europe and Africa as well as the Middle East. The region consists of 12 markets – UAE, Saudi Arabia, Qatar, Kuwait, Bahrain, Oman, Jordan, Lebanon, Egypt, Libya, Iraq and Palestine.

    PwC has been established in the region for over 40 years, we already employ over 4500 people and we are on course to become the Middle East number one professional service firm. More

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    General Insurance Underwiter | RTC-1 Employment Services

    Employment: Full Time

    Position Title: General Insurance UnderwriterEmployment Type: Full TimeSalary: up to 6,000 AED, all-inclusive depending on experience and qualificationsJob Location: Dubai, UAEAbout the Client:The hiring company is one of the leading insurance broker and consultant in the UAE.Job Role:- Analyze information stated on insurance applications- Determine the risk involved in insuring a client- Screen applicants on the basis of set criteria- Evaluate recommendations from underwriting software- Contact field representatives, medical personnel, and others to obtain further information

    Requirements:- 45 y/o and below- Bachelor’s degree in medical field or any relevant certificate (attested)- Minimum 5 years of experience in General Underwriting (with attested experience letter)- Previous insurance experience is a must- Knowledgeable of different network tariffs- Strong experience in dealing with insurers- Ability to manage clients, distribution teams, and insurers- Excellent interpersonal and communication skills

    RTC-1 Employment Services is a licensed recruitment firm based in Dubai, UAE. Our team has been in the market since 2004 and we are supporting various industries with their staffing needs across the Middle East and Africa. More

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    Healthcare Informatics Consultant – Senior Consultant to Director | Ernst & Young

    Employment: Full Time

    Do you want to help transform the delivery of healthcare to millions of people?The EY MENA health team is expanding. We have opportunities for experienced Digital Healthcare/Healthcare Informatics Consultants at all levels from Senior Consultant to Director. These roles are focused on the healthcare market and based within our Technology Consulting practice.Technology is transforming healthcare delivery and enabling new business and care delivery models. With new markets opening and technology advancing faster than ever, the healthcare technology space is becoming increasingly complex. Our clients rely on effective, sustainable, technology solutions, and they look to us to facilitate their needs. In Technology Consulting, you’ll use your analytical knowledge to streamline everything from Technology Strategy, Processes, designing and implementing solutions in our Technology Consulting team. In return, you’ll receive all the training you need to solve some of the most complex business issues around.Operating specifically and most frequently in the healthcare sector, you will help our healthcare clients transform their Digital landscape, using new technologies and new approaches to healthcare, to change how patients are treated in hospital and at home. As well as operating in the health sector, you will be a full member of our cross-sector Technology Consulting team and will have the opportunity to develop your career by working with clients across a wide range of sectors, in addition to healthcare.Your key responsibilities- Your key responsibility is to help our clients improve and, by doing so, to serve patients better.- You’re likely to spend most of your time directly influencing and engaging our clients, designing their transformation programs with them and supporting and coaching their staff as they implement change.- You will look to identifying and mitigating potential risks, while leveraging opportunities to make our clients’ services better.- We’ll also look to you to improve performance by identifying areas for development within their current processes and practices.- You’ll be working on complex projects for some of the most well-known clients in healthcare in MENA and potentially, also, across other industries.- In addition, you are expected to perform complete analyses within the scope of the project from the simple to the complex.- Structure methodologies, analyze, summarize the findings, and apply the findings to the project. Manage a section of work from simple to complex, understand the scope of the total project.- Design an approach and determine the resources needed to complete the project, select the appropriate methodology and complete the work, and develop the recommendations.Being on a project also includes managing the executive relationship with responsibility that require you to organize the team, structure the work plan, complete the work, introduce the work to the client and develop the implications for the client. As well as manage relationships by building a development strategy and deepen trust-based relationships. Drive the business impact of the project or more than one project and be part of multiple engagements for the client over time.

    Skills and attributes for success:To qualify for these roles, you must have:- A bachelor’s degree in a Health Informatics, IT, Public health, or Clinical discipline (Doctors & Nurses)- A record of excellence in providing advisory services focusing on Information Technology and performance improvement in the healthcare sector- Ability to develop, present new ideas and conceptualize new approaches and solutions- Have strong analytical and problem-solving skills- Have a solid understanding of health informatics domainsFor roles at Manager level and above you must also have:- Proven track record of effectively managing consulting workstreams, projects and/or client engagements.- At least 6-8 years of overall relevant experienceFor roles at Senior Manager/Director level you must also have:- At least 8-10+ years of overall relevant experience- Significant team leadership experience within a healthcare consulting environment- A significant track record of developing trusted client relationships, shaping solutions for clients, winning client contracts, leading successful engagement delivery and building recurring business relationships- Existing client relationship across the GCCIdeally, you’ll also have:- Master’s Degree in a related discipline- Relevant certifications, for example (CPHIMMS, Project Management)- Willingness to travel across the regionWhat we look for:We’re looking for people who are passionate healthcare consultants, at the top of their game, but who would like to continue to grow their subject matter expertise and help others around them achieve their potential. If you have a passion for assisting healthcare organisations achieve their full potential and working with some of the highest performing teams, this role might very well be for you.What working at EY offersWe offer a competitive compensation package where you will be rewarded based on your performance and recognised for the value you bring to the business. We also offer:- Support and coaching from some of the most engaging colleagues in the industry- Opportunities to develop new skills and progress your career- The freedom and flexibility to handle your role in a way that’s right for youAbout EYAs a global leader in assurance, tax, strategy & transactions and consulting services, we’re using the finance products, expertise and systems we’ve developed to build a better working world. That starts with a culture that believes in giving you the training, opportunities and creative freedom to make things better. Whenever you join, however long you stay, the exceptional EY experience lasts a lifetime. And with a commitment to hiring and developing the most passionate people, we’ll make our ambition to be the best employer by 2020 a reality.If you can confidently demonstrate that you meet the criteria above, please contact us as soon as possible.Build your legacy with us.Apply now.

    EY is a global leader in assurance, tax, transaction and advisory services. The insights and quality services we deliver help build trust and confidence in the capital markets and in economies the world over. We develop outstanding leaders who team to deliver on our promises to all of our stakeholders. In so doing, we play a critical role in building a better working world for our people, for our clients and for our communities.
    EY refers to the global organization, and may refer to one or more, of the member firms of Ernst & Young Global Limited, each of which is a separate legal entity. Ernst & Young Global Limited, a UK company limited by guarantee, does not provide services to clients. Information about how EY collects and uses personal data and a description of the rights individuals have under data protection legislation are available on our site.
    The MENA practice of EY has been operating in the region since 1923. For over 95 years, we have grown to over 7,500 people united across 21 offices and 16 countries, sharing the same values and an unwavering commitment to quality. As an organization, we continue to develop outstanding leaders who deliver exceptional services to our clients and who contribute to our communities. We are proud of our accomplishments over the years, reaffirming our position as the largest and most established professional services organization in the region More

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    Filipina Housemaid | Tabarak

    Employment: Full Time

    URGENT!Looking for FILIPINA Full Time Stay-In Housemaid(Direct hiring from employer)Employer : Emirati NationalLocation : Jumeirah, Dubai (Rest House)Work : Full Time Housemaid Only (No Kids)Salary : AED 2,000 (NEGOTIABLE) based on Experience.

    REQUIREMENTS:- FILIPINA FEMALE- Age 25-35 years old.- Can understand English.- Good in housekeeping.- Trustworthy & Honest.- Responsible- The ability to work with minimal supervision.- Physically fit and detail-oriented.

    Tabarak Commercial Investment (“TABARAK”) is a private equity vehicle established in the UAE by ambitious and well-known Emirati entrepreneurs with an extensive investment portfolio of successful businesses and partnerships. Founded in Abu Dhabi, the business hub of the Middle East, TABARAK has geared efforts towards expansion with a strong focus on the GCC with future plans of expanding internationally.
    TABARAK always aims, through its local and International networks and the leverage of its key resources, to successfully convert all its potential new business opportunities into mutually beneficial and successful partnerships with corporations and/or entrepreneurs inside and outside GCC. Further, TABARAK works closely with its partners to establish long-term relationships, identify and understand mutual interests and thus allows TABARAK to share in mutual success.
    The founders of TABARAK have a track record of achievements in private equity sector supported by extensive experience in various sectors. More

  • Hospital Business Planning | Hill International

    The Role
    Hospital Business Planning • Vital to an organization’s future, a business plan is a framework outlining the steps for financial and operational success. • For many hospitals, this process has occurred at five-year intervals tied to strategic planning efforts. • However, in today’s healthcare envir… More