Roles & Responsibilities:

• Product Management of Individual Medical and ensure that the competitive medical products are offered in the market with UAE market requirements.
• Coordinate with marketing/distribution channels/Direct Customers to address any potential service issues.
• Coordinate with Brokers/Direct Customers and follow up on retention and ensure that the retention levels are maintained at always agreed percentages.
• Coordinate with Customer Services team to get the regular feedback on service issues and customer satisfaction.
• Coordinate with IT team for any issues related to IT Portal (B2C or B2B).
• Update the Management on any issues with regards to Individual Medical products.
• Produce Management reports on a regular basis on retention, loss ratios and production and any other reports on time to basis.

Qualifications and Education Requirements:

• Bachelor’s Degree in related courses.
• Working knowledge Medical insurance products, procedures and regulatory requirements.
• Relevant experience of 3 – 5 yrs. in retaining individual medical customers via broker channel in UAE.

Skills & Competencies:

• Computer literate with superior skills in Microsoft Word, Excel and PowerPoint.
• Strong oral and verbal communication skills.
• Strong analytical skills (Analyzing data and creating reports for the management).
• Sound interpersonal skills at all organizational levels with the ability to establish rapport with personnel across a wide variety of areas.
• Target oriented with an ability to work under minimal supervision.

Job Purpose:

To be responsible for performing providers Audit Campaign, and identifying unfavorable trends in providers billing, maximize audit findings and recovery through providing solid audit ground.

Responsibilities:

• Assists the Line Manager in implementing and managing claims denial, approvals communication and management with TPA, health care provider, insured member and health care regulators (Dubai Health Authority/ Health Authority of Abu Dhabi). Conducts medical audit for fraud, waste or abuse with health care providers.
• Assists in the review of claims which are suspected for abuse and medical claims audit with TPA.
• Responds for home country members approval and claim coordination with TPA.
• Implements knowledge of HAAD/ DHA regulations without TPA on claims management.
• Performs audit of TPA performance.

Minimum Requirements:

• Completed MBBS / MBChB/ Equivalent Degree.
• Proficient knowledge of HAAD & DHA.
• Working knowledge of general practices for medical insurance procedures.
• At least 1 – 3 years’ experience in a similar role in Healthcare Audit with coding experience in the UAE Insurance Industry.
• Freshers with MBBS / MBChB/ Equivalent Degree may also apply.
• Good communication skills in Arabic both written & oral.
• Candidates having work experience as Medical Doctors in Government Hospitals in the UAE (Preferable).
• Coding certification; CPC & IPDRG (Preferable).

Roles & Responsibilities:

• Analyzes and reviews quotations (new cases & renewals) as requested by the Sales Department for clients/brokers.
• Receives quotation templates and ensures all information provided is accurate and complete.
• Verifies all relevant client information provided by the sales staff/clients/brokers, e.g. General Company Data, Claims Loss Ratio etc. in order to use for risk assessment.
• Based on the quotation template and data provided by the sales team/clients/brokers, assesses the level of risk and adjusts the rates accordingly and forwards to Operations for further processing.
• Approves/ denies the quotation generated by U/W team based on risk assessment according to authority levels and refer where required to the U/W Manager.
• Analyzes current year claims utilization in order to prepare renewals terms for all relevant clients.
• Assists Underwriting Manager with preparing quotes for various tailor-made products for clients that may require policy schemes and plans that are not a part of the Company’s standard insurance plan.
• Responds to general queries about pricing from the Brokers/Sales Department, providing them with all necessary information for the client.
• Participates in performing renewal calculations/ assessment on monthly basis for cases due for renewal within the approved authority and refer cases above the authority to immediate manager.
• Assists in preparing monthly and quarterly Claim/ Loss ratio reports for the Senior Management.
• Assists Underwriting Manager in management of day-to-day work by involving in work allocation, priority setting, review and update of procedures, involvement along with Manager in trainings and presentations.
• Updates the U/W manager on the work volumes, pending, review of SLA, discussion and involvement with system projects and any other projects that can help simplify work and improve the service.
• Coordinates with reinsurers in line with treaty guidelines.
• Prepares quotes in line with market trends and working in line with regulatory (DHA/IA/HAAD) guidelines.
• Carries out any such other task as requested by the Department Manager.

Qualifications and Education Requirements:

• Bachelor’s Degree in related courses.
• Working knowledge of general practices for Medical insurance procedures.

Skills & Competencies:

• Computer literate with superior skills in Microsoft Word, Excel and PowerPoint.
• Strong oral and verbal communication skills.
• Sound interpersonal skills at all organizational levels with the ability to establish rapport with personnel across a wide variety of areas.
• Goal oriented with an ability to work under minimal supervision.
• Superior attention to detail with the ability to take ownership of issues / projects and see them through to resolution, implementation and completion with minimal supervision.

Experience:

• Minimum 4 to 6 years of relevant experience in Medical Underwriting in UAE.