Medical Insurance Manager

A reputable medical company in Jeddah is seeking a <b>Medical Insurance Manager</b> to oversee and optimize its medical insurance operations. This role requires a highly skilled professional with a strong background in insurance management, claims processing, regulatory compliance, and financial oversight. The ideal candidate will possess leadership qualities, excellent analytical skills, and the ability to navigate complex insurance policies while ensuring seamless healthcare coverage for patients and efficient reimbursement processes for the company.

<b>Key Responsibilities:</b> <br>

• Develop, implement, and oversee the company’s medical insurance policies and procedures to ensure compliance with Saudi insurance regulations. <br>
• Manage relationships with insurance providers, negotiate contracts, and ensure optimal coverage terms for the organization. <br>
• Supervise the processing of medical claims, approvals, and reimbursements, ensuring accuracy and timely submission to insurance firms. <br>
• Monitor compliance with insurance policies, identify risks, and implement corrective measures to mitigate financial liabilities. <br>
• Utilize advanced medical coding systems such as ICD-10 and CPT to facilitate accurate billing and claims processing. <br>
• Train and support the insurance team in handling approvals, billing, and dispute resolution with insurance providers. <br>
• Conduct periodic audits to evaluate billing discrepancies, improve reimbursement efficiency, and enhance insurance-related workflows. <br>
• Liaise with medical staff and finance teams to ensure seamless communication regarding insurance coverage, claims, and cost management. <br>
• Stay updated on changes in insurance laws and regulatory frameworks affecting healthcare coverage in Saudi Arabia. <br>
• Provide strategic recommendations to enhance the company’s insurance policies and optimize financial performance related to healthcare claims.
  <br> <br> <b>- Qualifications & Requirements:</b> <br>
• Bachelor's degree in Business Administration, Insurance, Healthcare Management, or a related field. <br>
• Minimum of 5 years of experience in medical insurance management or related roles. <br>
• Strong knowledge of Saudi insurance laws, medical reimbursement processes, and provider contract negotiations. <br>
• Expertise in insurance claims approvals, dispute resolution, and medical billing procedures. <br>
• Advanced proficiency in ICD-10 and CPT coding systems for accurate claims processing. <br>
• Demonstrated leadership abilities with experience in managing an insurance operations team. <br>
• Excellent communication, negotiation, and problem solving skills. <br>
• Fluency in Arabic and English, with professional writing capabilities.