Medical Benefits Officer

Job Purpose: 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. Authorise 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
effective claim and pre-approval processing and business operations. Specific
to Projects - Support the department with technical support to establish
improved processes and system integration, design and create automated reports
and dashboards to standardise management reporting. - During project activity,
verify all published material including but not limited to the MB Manual
(T&Cs, Network list, Guide, Exclusions and TOB) group world site and MB
SharePoint to ensure all entries are current and approved as per audit
guidelines. - Design and publish medical benefits customer communications such
as insurance briefings, Info sheets, application forms or scheme updates
ensuring they are clearly communicated and marketed to new or promoted
employees, to make sure there is a clear understanding of the policy. Design
and present other briefs to staff as appropriate. As part of the MB projects
team maintain an up to date, easy to use internal SharePoint and customer
group world page. - Work with the Manager to recommend policy and process
changes to improve efficiency, cost and quality across operations and assist
the Manager in administering operating procedures and tariffs with external
medical providers.
Qualifications & Experience: MINIMUM
QUALIFICATIONS/EXPERIENCE/KNOWLEDGE/SKILLS Experience: Medical/Clinical/ Other
Medical Specific to Claims and pre-approval processing Degree or Honours (‎12+‎3
or equivalent) - MBBS Specific to Projects Degree or Honours preferably (‎12+‎3
or equivalent) in a relevant medical field with relevant clinical experience.
Any other additional non-healthcare experience is preferred. Experience ‎4-‎5
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.