The Emirates Group
Medical Insurance Approval Officer
JOB PURPOSE Support the Manager in pre-approval, medical claims or customer service operations and ad hoc project work across the department to ensure adherence to company policies, standard operating procedures and regulatory authorities mandates. In all areas, maximise the use of automation to limit company expense and improve efficiency. Ensure that Medical Benefits (MB) policy and procedures are upheld in all operational activity. Administrate projects, scheme updates and process revisions in line with MB objectives and management direction ensuring accurate documentation of process and policy change in line with audit parameters. Support management reporting with reports and dashboards.
JOB ACCOUNTABILITIES LINKED TO OBJECTIVE AREAS
Generic – Support claims, pre-approvals and customer support teams across medical and administrative operations to ensure they are operated effectively within the MB team thereby ensuring consistency. Work with the Manager to identify and monitor quality and establish problem areas and implement corrective action. – Maintain a consistent business process review approach making maximum use of automation to improve speed and quality of internal processes and the customer experience. – Compile feedback from various sources thereby measuring external medical providers and healthcare benefits, documenting and investigating to seek recommendations for quality improvements. Specific to Claims and pre-approvals processing – Process pre-approvals and medical claims to determine cover in line with company terms and conditions. Make decisions with regards to payment, denials, investigations and reimbursement ensuring that company policies and regulations have been accurately applied within the set time frames. – Authorise urgent medical claims and/or medical treatment at external medical providers within set SLAs. Procedures need to be reviewed regularly and, where required, escalate external provider trends to ensure our employees are given an excellent standard of medical care and internal support. Authorize approvals, reimbursements and direct billing invoice payments in-line with the applicable Medical Benefits Manual. – Correspond and communicate via telephone, email or personal visits with covered members, doctors, internal stakeholders and external medical providers to discuss and resolve matters relevant to the effective claim and pre-approval processing and business operations.
Qualifications & Experience:
Experience: Medical/Safety/ Other Medical Specific to Claims and pre-approval processing Degree or Honours (12+3 or equivalent) in Nursing Specific to Projects Degree or Honours (12+3 or equivalent) in a relevant business field with relevant experience (medical insurance HR policy, projects etc.) Experience 2+ yrs Knowledge/skills: Knowledge of claim examination procedures and standard insurance procedures. Knowledge of medical terminology is desirable. Knowledge of company insurance schemes and the reimbursement and benefits system would be an advantage. Proficient in written and spoken English. Computer literate and proficient in the MS Office Suite of Software with advanced Excel skills. Preferred knowledge of web based tools such as SharePoint and Business Intelligence Leadership Role : NO
Salary & Benefits: We offer an attractive tax-free salary, paid in Dirhams, the local currency of the UAE. The Dirham is linked to the Special Drawing Right of the International Monetary Fund. It has been held constant against the US dollar since the end of 1980 at a mid-rate of approximately US$1= Dh3.66. Besides travel benefits normally associated with an airline, more information on employee benefits is available within the ‘Working Here’ section of this site. By viewing the ‘Dubai Lifestyle’ section in the site you can also consider the benefits of Dubai as a location to live and work in.
To apply for this job please visit www.emiratesgroupcareers.com.