Resubmission & Reconciliation Officer, Al Futtaim Health, Dubai, UAE

This job is OPEN for ALL Nationalities to Apply, unless otherwise specified.

Read the Job Description carefully, then scroll down for "Details to Register for this Job"...

Job Requisition ID: 159937 

Established in the 1930s as a trading business, Al-Futtaim Group today is one of the most diversified and progressive, privately held regional businesses headquartered in Dubai, United Arab Emirates. Structured into five operating divisions; automotive, financial services, real estate, retail and healthcare; employing more than 35,000 employees across more than 20 countries in the Middle East, Asia and Africa, Al-Futtaim Group partners with over 200 of the world's most admired and innovative brands. Al-Futtaim Group’s entrepreneurship and relentless customer focus enables the organization to continue to grow and expand; responding to the changing needs of our customers within the societies in which we operate. 

By upholding our values of respect, excellence, collaboration and integrity; Al-Futtaim Group continues to enrich the lives and aspirations of our customers each and every day

 

About the role:

To update Insurance manager about unusual denial / issues from Insurance Companies for further discussion and resolution.

Ensure timely resubmissions of all eligible IP,OP and Pharmacy claims with proper medical and technical justification.

Internal Follow up for raised QMS to concerned branch

Communicating with the payers for any clarification regarding the rejected claims at 1st resubmission and 2nd resubmission-reconciliation stage.

Interacting with the physicians for the clinical justification on the rejected claims

Ensure and work closely with the team on complex cases that need experience and specialist knowledge or technical IT support.

Working closely with Insurance Approvals and Claims Submission Team to minimize the claims denials

Making sure that claim resubmissions are dealt with according to Insurance industry and DHA regulations.

Comply with re-submission KPI’s (Key Performance Indicator) , maintain a record of resubmission KPIs as and when required.

Analyze the root cause for the denial by the various payers and collect timely feedback from other team members, create a special rules in the system to prevent the reoccurrence of those denials

Educate billing/Approval team to enhance the process flow.

Ensures that targets are met with in turnaround time and while maintain quality and productivity.

Coordinate with CDI team to educate the physicians, and other paramedical team to ensure proper claims documentations.

Maintain accurate monthly data of claims resubmissions /reconciliations of each insurance company

Maintain a detailed statement of insurance denials segregated to technical denials and medical denials to facilitate the proper denial management plan and required training and documentation enhancement

Highlight payment discrepancies by various payers to LM knowledge.

Coordination with other business stakeholders to improve overall resubmission /recon process efficiency.

Analysis of financial data related to revenue cycle, to identify defaulting payors and work with the concern department on corrective strategies to mitigate the financial risk/s.

 

Required skills to be successful:

Job-Specific Skills:

Strong medical background to handle reconciliation efficiently.

Strong Negotiation skills

Strong soft skills

Behavioural Competencies:

Excellent presentation and analytical skills

Good decision-making skills

Strong operational thinking skills

Strong dedication skills

Ability to work under pressure to achieve target  

What qualifies you for the role:

Minimum Qualifications and Knowledge:

Certified professional coding certificate from reputed institution

Certified medical /paramedical certificate

Minimum Experience:

Minimum 3+ years’ experience in a similar role. 

About Al-Futtaim Healthcare

We Hear Your Ambition.

For over 90 years, the Al-Futtaim Group has been bringing the world’s leading brands of lifestyle watches, cars, home furnishings and fashion to the UAE. The Group has now introduced a whole new way of holistic healthcare through HealthHub Clinics by Al-Futtaim, its multi-speciality chain of more than 20 clinics in Dubai with over 25 specialties offering the right combination of advanced diagnostics, proven medical expertise and specialised services. 

What gives our clinics an edge is that as a part of the Al-Futtaim Group, you can expect world-class quality standards, with access to the best medical services and facilities within a healing environment. It’s a new way of healthcare that’s designed to meet a patient’s needs with a complete range of smart healthcare solutions. As testimony to this, only recently, we’ve earned a rare milestone of being the only primary healthcare network in the UAE to receive the Gold Seal by a reputed international body: Accreditation Canada.   

As trusted partners to health, we at HealthHub Clinics adopt evidence-based learning that enables us to listen to our patients more carefully. It helps us in treating the cause and not just the symptoms, while applying global best practices to ensure quality of care for every family member. Most of all, we adopt a patient-centric approach to healthcare that is reflected in the promise of our core belief: “We Hear You.”

DETAILS TO REGISTER FOR THIS JOB:
NOTE: ATS-compliant CV is MANDATORY!

https://www.afuturewithus.com/job/Resubmission-&-Reconciliation-Officer-Al-Futtaim-Health-Healthcare/1039001501/



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Business Development Reinsurance Manager, NEXTCARE Claims Management LLC, Dubai, UAE

This job is OPEN for ALL Nationalities to Apply, unless otherwise specified.

Read the Job Description carefully, then scroll down for "Details to Register for this Job"...



What you do

 

The BD Relationship Manager  acts as the point of contact between NEXtCARE and its client (SAADA). This role has an overall responsibility to maintain the current business as well as maximizing the business opportunities within existing client.
 
This role has an overall responsibility to provide excellent customer service, meet clients’ needs and ensure highest satisfaction levels.

 Main tasks:

     Establishes regular meeting with the client (SAADA) at least twice per month.
    Creates visibility around actions related to all activities related to this account and regular reporting of the same.
    Coordinates among various  stakeholders within the organization in order to ensure client deliverables.
    Establishes list of expected deliverables on Quarterly basis.
    Conducts surveys to SAADA members in order to generate statistics related to quality improvements and customer satisfaction.
    Resolves customer complaints regarding services, in coordination with relevant teams.
    Works with the client on generating  ideas and  digital initiatives that capitalize on existing and prospective partner strengths to drive additional benefit to NEXtCARE portfolio.
    Stays current and knowledgeable on all products, service offerings and trends within the industry.
    Works closely and coordinates effectively with solutions and services departments of Company to ensure smooth and quality delivery of products and services on time.
    Effectively interacts with other departments including the account management.
    Ensures NEXtCARE remains proactive and responsive to prospective clients.
    As required recruit, train and supervise staff.


What you bring

 Behavioral Requirements:

     Possess drive, motivation and acute attention to detail in ensuring all business opportunities to NEXtCARE are captured and explored.
    Sound knowledge of International Standards related to Health and Medical Insurance quality measures, region markets and practices.
    Able to analyze data and suggest techniques and requirements.
    Strong negotiation, communication, time management and leadership skills.
    Ability to work independently and maintain focus under pressure.
    Problem solving and decision making.
    Solid understanding of business dynamics, planning and execution.
    Ability to self-manage workload and handle multiple accounts, working with people at all levels of an organization.
    Must demonstrate strong initiative with ability to work as part of a team as well as independently.
    Demonstrate sound financial acumen in order to proactively respond to business trends.

 

Behavioral Competency:

 

Customer & Market Excellence:

    Strive for excellence at every touch point with the customer
    Foster state-of-art  technical/operational knowledge and strive for continuous simplification
    Be the benchmark

Collaborative Leadership:

    Empower the team and provide purpose and direction
    Develop people, provide  feedback and care to employee wellbeing
    Collaborate and exchange best practice.

Entrepreneurship:

    Act on opportunities, anticipate trends, take risk, and promote a culture that allows for honest failure
    Take ownership and responsibility
    Embrace innovation and a culture that allows to make decisions without fear of retribution.

Trust:

    Act with integrity, honor commitments, tell the truth
    Foster diversity and inclusiveness
    Act transparently and promote corporate social responsibility.

 Minimum Requirements
 

    Bachelor’s Degree.
    5+ years of experience in a similar role within a TPA, insurance or brokerage firm.
    Physically fit to carry out duties.
    Legally permitted to work in the country of operations.
    Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.


41405 | Sales & Distribution | Professional | Non-Executive | Allianz Partners | Full-Time | Permanent

Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams and challenges, is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow and to shape a better future for our customers and the world around us.
We at Allianz believe in a diverse and inclusive workforce and are proud to be an equal opportunity employer. We encourage you to bring your whole self to work, no matter where you are from, what you look like, who you love or what you believe in.
We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, disability or sexual orientation.
Great to have you on board. Let's care for tomorrow.

DETAILS TO REGISTER FOR THIS JOB:
NOTE: ATS-compliant CV is MANDATORY!

https://careers.allianz.com/job/Dubai-Business-Development-Reinsurance-Manager/1038080401/



Also, Copy-Paste Your CV in the Comments section.



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...And, you'll keep wondering why you get rejected in spite of being a PERFECT MATCH for the Job.


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We support the Far-Sighted, Growth Oriented Vision announced by the UAE, Saudi Arabia, Qatar, Oman, Kuwait and Bahrain.


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SOCIAL INITIATIVE:

We publish job vacancies on this website and our Whatsapp groups for the benefit of job-seekers.


It is to help people who are searching for jobs from across the world.


This is a Social Initiative from our team @ dubai-forever.com, so please help us in this Noble Task by Forwarding these jobs within your Network.


Do this GOOD DEED.


You never know who will benefit from it.


You've heard about KARMA right?


It's waiting to give you 10X of whatever you do...Do the Good Deed. NOW!


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Claims Management Coordinator, Allianz Partners, Doha, Qatar

This job is OPEN for ALL Nationalities to Apply, unless otherwise specified.

Read the Job Description carefully, then scroll down for "Details to Register for this Job"...
SUMMARY

Claims Management - Coordinator is responsible for tracking of Direct received from healthcare providers from various claim sources (Physical Documents from courier/messenger, FTP, E-mail, etc.) according to NEXtCARE standards. Claims Management Coordinator tasks include Intimation of received claims statement of account versus processed claims records in the system as well Manual Payment Order generation if required and Payment Order releasing and delivery to Finance or to the respective insurance companies for prompt payment and settlement.

 

MAIN TASKS

Consistently checks and tracks claims received from providers which includes the following responsibilities:

Checks claim submission for proper completion.
Intimation of physical claims versus the statement of account.
Ensures that direct claims submitted by healthcare providers are sorted and segregated per payer.
Ensures that standard format for submission is followed such as general statement of account and detailed statement of account.
Scanning of physical claim documents (Claim Forms, Medical Reports, invoices, etc.).
Archiving of scanned claim documents and FTP Folders.
Ensures feedback within set specified time for any corrections, missing information, and any standard format not being followed by the provider.
Accurate creation of claims batches according to archived and physical claim documents.
Ensures that all claim batches are routed accordingly to next function users (Claims Processing, Medical Review, OFR/Audit)
Ensures that all validated claim batches are created inside the payment order for releasing and delivery to finance and respective insurance companies within the set KPI and NEXtCARE standards.
Ensures that returned Payment Orders for re-evaluation are recorded and endorsed to the concerned department.

Ensures proper documentation, feedback, and endorsement on the following:

Missing information on the claim and standard format of submission are not followed for Network Operations to contact the providers.
Claims with incomplete administrative information to be returned to the provider.
 

BEHAVIORAL REQUIREMENTS

 

•Attention to detail and ability of multi-task.
•Organizational & time management skills.
•Excellent team player.
•Ability to meet tight deadlines.
•Ability to work under pressure to tight deadlines.
•Strong communication skills.
•Ability to work well with all levels of internal management and staff, as well as outside clients and users.
•Ability to demonstrate sounds work ethics.
•Show flexibility with excellent interpersonal skills.
•Flexible to work in shifting schedule.
•Demonstrate commitment to produce output base results.
•Ability to clearly communicate concepts verbally and in written form is a mandatory requirement for this position.
•Demonstrable commitment to producing output-based results.
 

BEHAVIORAL COMPETENCY

Customer & Market Excellence:

•Strive for excellence at every touch point with the customer
•Foster state-of-art  technical/operational knowledge and strive for continuous simplification
•Be the benchmark
Collaborative Leadership:

•Empower the team and provide purpose and direction
•Develop people, provide  feedback and care to employee wellbeing
•Collaborate and exchange best practice.
Entrepreneurship:

•Act on opportunities, anticipate trends, take risk, and promote a culture that allows for honest failure
•Take ownership and responsibility
•Embrace innovation and a culture that allows to make decisions without fear of retribution.
Trust:

•Act with integrity, honor commitments, tell the truth
•Foster diversity and inclusiveness
•Act transparently and promote corporate social responsibility.
 
MINIMUM REQUIREMENTS
•Bachelor’s Degree; Paramedical background preferred.
•2+ years filing/documentation experience. Experience within the Health Care Industry, TPA’s, insurance companies, Hospitals, Medical Centers is a plus.
•Physically fit to carry out duties.
•Physically fit to carry out duties.
•Legally permitted to work in the country of operations.
•Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills
.

41210 | Operations | Entry Level | Non-Executive | Allianz Partners | Full-Time | Permanent

Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams, and challenges, is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow and shape a better future for our customers.

We at Allianz believe in a diverse and inclusive workforce and are proud to be an equal opportunity employer. We encourage you to bring your whole self to work, no matter where you are from, what you look like, who you love or what you believe in.

We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, disability, or sexual orientation.

Join us. Let's care for tomorrow.

Note: Diversity of minds is an integral part of Allianz' company culture. One means to achieve diverse teams is a regular rotation of Allianz Executive employees across functions, Allianz entities and geographies. Therefore, the company encourages its employees to be motivated in gaining varied skills from different positions and to collect experiences from across Allianz Group.

DETAILS TO REGISTER FOR THIS JOB:
NOTE: ATS-compliant CV is MANDATORY!

https://careers.allianz.com/job/Doha-Claims-Management-Coordinator/1036714801/

Also, Copy-Paste Your CV in the Comments section.



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