Medical Claims Supervisor - Amman, الأردن - DOROOB HR CONSULTING & RECRUITMENT

وصف

• Define, propose and, once approved, implement specific action plans targeted at managing and/or handling claims/benefits, and control and monitor the technical, financial and quality-related management variables within their remit, to improve the quality of the services delivered and ensure that the qualitative, underwriting and financial results are achieved.
• Resolve coverage issues, negotiate and approve coverage denials or settlement amounts within their previously established limits .
• Oversee medical, insurance and legal aspects of assigned complaints and complex/escalated claims.
• Supervise and coordinate the claims handling processes within their remit, and provide advice and support to the staff under their direction, actively participating in the management and resolution of those claims which are more complex or larger, duly coordinating their teams and, where necessary, external management teams, to achieve that the efficiency, quality and management targets are met while providing a highly motivated and customer-centric work environment.
• Coordinate the fight against fraud, to ensure strict compliance with the contractual obligations undertaken and the optimization of the technical results of the insurance lines concerned.
• Coordinate the control and monitoring of the technical, financial and quality-related management variables within their scope of responsibility to optimize costs and increase the quality of the service delivered.
• Promote an appropriate organization of the human and material resources in the area, and coordinate the employees under their direction, encouraging the development of actions that help integrate, develop and disseminate, across all levels, the unit's strategy and policies, while providing a suitable work environment with a focus on innovation, growth and profitability.