Medical Claims Executive - -Dubai
Dubai -Job Description: »Evaluates and processes claims in accordance with insurance policy terms and conditions, company policies and procedures according to productivity and quality standards. »Ensures that targets are met for department Turnaround time, Quality and Productivity. »Identify and report back any type of claims observation or issues that may affect the process. »Collect and analyze claims data to identify and resolve errors, delayed claims, and processing issues. Providing recommendations to take steps to improve the claims processing quality standards and productivity. »Analyze reports from the administrative software for provider and member utilization trends and identification of areas requiring further management. »Support the Team leader / Manager in implementation of quality assurance programs in order to maintain standards of quality and minimize fraudulent cases. »Handling medical related call queries. »Maintain confidentiality with regard to the information being processed, stored or accessed. »Completes other projects and duties as assigned. Skills and qualification requirements: »Should be willing be to work shifts (morning, evening and night shifts) »Must be an MBBS Graduate »Candidates able to start immediately preferred »2 years minimum clinical experience
Clinical Manager - ARE - Delta Technology and Management Services FZ LLC-Dubai
Dubai -Job Summary We’re looking to recruit a Clinical Manager to join the team that has been named the Middle East Insurance Review’s Service Provider of the Year for five consecutive years. The job entails managing all clinical and medical (non-actuarial) related projects in the GCC region pioneer the establishment of a clinical team in Dubai -. The environment is fast paced and encourages innovation. Our team is highly self-directed. We’re looking for others to join us who will take ownership of responsibility, work collaboratively and always look for ways to add to the personal and professional growth of the company and their peers. The successful candidate should have rich clinical experience, awareness of the GCC healthcare and payer market concepts, good understanding of medical coding and possess excellent communication and problem solving ability. The candidate would also be expected to have a good understanding of the emerging and developed market health landscapes and excellent project management skills. Primary Responsibilities As a clinical manager and analyst, this professional will join our team to assist in all phases of the clinical specs development life cycle. We are looking for a person with ability to: Manage all health related (non-actuarial) projects Create clinical logic and coding algorithms Work both independently and in a cross-functional team environment. Work independently on assigned tasks, i.e. plan, organize, delegate, problem solve and meet established deadlines. Write blogs and white papers on the potential value and benefits of Milliman products for clients through health claims data analytics. Skills and Requirements Candidates must be team players with excellent interpersonal skills. This position requires the following minimum requirements: Mandatory: B.B.S or Bachelor’s degree in healthcare domain – medical doctor, nurse or allied health professionals; MBA or Master’s degree in health management / healthcare administration or health insurance or business administration. 4-7 years of healthcare strategy or management consulting experience with payers, government or healthcare service organisations Proficiency in data analysis skills Superior communication, consulting and analytical skills Understanding of clinical codes and reimbursement methodologies Awareness of health policy developments, value based payment mechanisms and insurance designs Proficiency in Arabic – both spoken and written. Excellent verbal and written communication skills; Strong MS office skills; Desirable: CPC certification in coding; Proficient in SQL. About Milliman’s MedInsight Clinical Team Milliman is the largest global firm in life insurance and health consulting with over 3800 associates across 59 offices worldwide. Our Health IT software team has been developing and selling data warehousing solutions for over twelve years. The Milliman MedInsight practice has assisted many healthcare organizations in evaluating and developing solutions to complex business problems. Our consultants are experienced in the key issues related to healthcare operations and the use of technology to support those operations. Because of our focus on those unique technology and operations issues facing the healthcare industry, we are uniquely qualified to assist organizations in solving complex business problems Qualifications Education Required Bachelors or better in Medicine or related field. Masters or better in Medicine or related field. Experience Required CPC Certification in coding Proficiency in data analysis skills Awareness of health policy developments, value based payment mechanisms and insurance designs 4-7 years: Healthcare strategy or management consulting experience with payers, government or healthcare service organisations
Clinical Manager - ARE - GloboPrime-Dubai
Dubai -Job Summary We’re looking to recruit a Clinical Manager to join the team that has been named the Middle East Insurance Review’s Service Provider of the Year for five consecutive years. The job entails managing all clinical and medical (non-actuarial) related projects in the GCC region pioneer the establishment of a clinical team in Dubai -. The environment is fast paced and encourages innovation. Our team is highly self-directed. We’re looking for others to join us who will take ownership of responsibility, work collaboratively and always look for ways to add to the personal and professional growth of the company and their peers. The successful candidate should have rich clinical experience, awareness of the GCC healthcare and payer market concepts, good understanding of medical coding and possess excellent communication and problem solving ability. The candidate would also be expected to have a good understanding of the emerging and developed market health landscapes and excellent project management skills. Primary Responsibilities As a clinical manager and analyst, this professional will join our team to assist in all phases of the clinical specs development life cycle. We are looking for a person with ability to: Manage all health related (non-actuarial) projects Create clinical logic and coding algorithms Work both independently and in a cross-functional team environment. Work independently on assigned tasks, i.e. plan, organize, delegate, problem solve and meet established deadlines. Write blogs and white papers on the potential value and benefits of Milliman products for clients through health claims data analytics. Skills and Requirements Candidates must be team players with excellent interpersonal skills. This position requires the following minimum requirements: Mandatory: B.B.S or Bachelor’s degree in healthcare domain – medical doctor, nurse or allied health professionals; MBA or Master’s degree in health management / healthcare administration or health insurance or business administration. 4-7 years of healthcare strategy or management consulting experience with payers, government or healthcare service organisations Proficiency in data analysis skills Superior communication, consulting and analytical skills Understanding of clinical codes and reimbursement methodologies Awareness of health policy developments, value based payment mechanisms and insurance designs Proficiency in Arabic – both spoken and written. Excellent verbal and written communication skills; Strong MS office skills; Desirable: CPC certification in coding; Proficient in SQL. About Milliman’s MedInsight Clinical Team Milliman is the largest global firm in life insurance and health consulting with over 3800 associates across 59 offices worldwide. Our Health IT software team has been developing and selling data warehousing solutions for over twelve years. The Milliman MedInsight practice has assisted many healthcare organizations in evaluating and developing solutions to complex business problems. Our consultants are experienced in the key issues related to healthcare operations and the use of technology to support those operations. Because of our focus on those unique technology and operations issues facing the healthcare industry, we are uniquely qualified to assist organizations in solving complex business problems Qualifications Education Required Bachelors or better in Medicine or related field. Masters or better in Medicine or related field. Experience Required CPC Certification in coding Proficiency in data analysis skills Awareness of health policy developments, value based payment mechanisms and insurance designs 4-7 years: Healthcare strategy or management consulting experience with payers, government or healthcare service organisations