تصنيف الوظيفة: التأمين

التأمين

Senior Financial Risk Analyst I

JOB PURPOSE / OBJECTIVE :

Senior Financial Risk Analyst I

Senior Financial Risk analyst identifies, assesses, and monitors the volume of risk that the organization is exposed to, such as credit risk, liquidity risk, market risk, operational risk, counterparty risk, and cyber risk then develops risk mitigation strategies to eliminate any major impact on the business results.

Key Accountabilities & Working Relationships
Job Responsibilities

Senior Financial Risk Analyst I

  • Quantifying the potential negative effects of risk-related activities
  • Identifying practices within the organization that contribute to increased financial risk
  • Reviewing the industry-related developments and other resources
  • Research and study the events in the current scenario and anticipate any effect on the economy as well as the financial industry
  • Compiling reports, summaries, and presentations to communicate findings to key stakeholders within the business
  • Collaborating with risk managers on reporting and evaluation techniques to support the ongoing collection and interpretation of risk management data
  • Constantly keeping a check on the compliance requirements
  • Create contingency plans for emergency cases such as a market crash because of a pandemic situation, government policy change, etc.
  • Hedging the risk
  • Developing vendors’ evaluation process and deploying credit data and financial statements analysis for the counterparties.
  • Collaborating with the ERM department in assessing, reporting, and mitigation strategies for financial risks.

Senior Financial Risk Analyst I

Business Expertise :
  • Knowledge of finance and risk management Principles and Practices
  • In-depth work experience in Risk Analysis, BCP, Crisis Management, and Advance Analytical Capabilities.

 

Leadership
  • Finance Development
  • Developing personal banking knowledge and skill set with a continuous improvement ethos
  • Banking Knowledge Transfer & Acumen
  • Contribute to workshops for key elements in the banking management process
  • Banking reports
  • Contribute to new or revised current Treasury policy and procedures as required by the business while operating within the company’s policy

 

Problem-Solving
  • Analytical mind and a good hold of mathematics
  • Knowledge of data analysis
  • Strategic mindset for mitigating risk
  • A go-getter attitudes

 

Nature of Impact
  • Coordination skills to understand the requirements of different departments about risk
  • Highly ethical Contribute to workshops for key elements in the risk management principals

 

Area of Impact
  • Business Wide, All Stakeholders
  • The impact is across JV Partners, JV Board, JV C suite, Business functions, Government Authorities, Government Auditors, JV Partner Auditors, JV Clients and JV Supply chain

 

Interpersonal Skills
  • Strong Communication Skills
  • Self-Starter and Self-Motivated
  • Team Player Whilst being able to Deliver Individually
  • Cultural Awareness

 

Education
  • Bachelor’s in Business, preferred Master’s degree in Risk Management, Insurance, Finance, Accounting, Economics, Business Administration or related fields
  • Professional Qualifications (Certifications & Accreditations)
    Professional Qualification in Risk Management, Risk Analysis, FRM, ARM, CFA, and/or PRM.

 

Experience
  • 5 – 10 years of work experience in insurance & risk management or banking field preferred
  • Finance reconciliation experience
  • ERM, Gap Analysis, Risk Register, and BCP practitioner

 

Internal Interactions
  

Finance Department

Business Functions & Employees

 
External Interactions
  

Minimal exposure –Audit and Government Authorities

 
Experience
Customer Focus

Identifying and Anticipating Customer Needs
o Displays an interest in the customer by trying to understand their concerns and issues; draws on customer insight to help others with how to best meet current and future customer needs
• Customer Care/Service
o Develop positive internal and external customer relationships by consistently and efficiently delivering value
• Following Customer Service Trends
o Shares best practice knowledge with others in the work team; identifies ways in which the customer experience could be enhanced.

Collaboration/Teamwork

• Delivering Information and Assistance
o Actively participates in meetings by providing input, expressing opinions, and offering solutions; ensures that others have an opportunity to voice their thoughts
• Role Identity and Interpersonal Interactions
o Works openly and dependably with team members; assumes individual contributor or manager roles as needed
• Building/Maintaining Relationships and Fostering Cooperation
o Establishes and grows working relationships; seeks out and encourages different and diverse ideas from others.

Initiative

• Addressing Gaps in Work
o Anticipates and takes action on what needs to be done to accomplish an objective, task, or goal; finds alternative or less obvious ways to carry out plans
• Motivating and Energizing Self and Others
o Sets challenging yet motivating short and long-term goals that lead to beneficial individual and team results
• Self-Starting
o Accepts ownership for individual performance, results, and actions; volunteers for tasks before being asked by others or being forced by events.

Accountability

• Taking Responsibility and Ownership
o Takes responsibility for achieving job requirements, tasks, and objectives even if other resources are required
• Driving and Delivering Results
o Willingly and appropriately goes beyond the scope of one’s job to get the work done and meet commitments made to others
• Managing Expectations and Working Through Setbacks
O Takes responsibility for individual and team errors by personally fixing problems and unintended consequences.

Knowing the Business

• Understands Operational and Financial Factors
o Applies understanding of operational and financial factors that drive team performance to contribute to department success
• Understands Company Products, Services
o Applies knowledge of the organization’s products/services and competitive landscape to deliver on team goals
• Collects and Evaluates Metrics/Data to Determine Actions
o Gathers and evaluates information about the organization’s overall performance to inform priorities.
A. Additional / Other Requirement:
• Delegate for Finance Supervisor as required

About Application Process :

If you meet the criteria and are enthusiastic about the role, we welcome your application. To complete the application you would need the following document(s):

1. Resume/CV
2. Relevant Certifications

Medical Insurance Senior Specialist

JOB DESCRIPTION :

Medical Insurance Senior Specialist

  • This role will be leading and managing the medical approvals, insurance claiming, and Billing process with insurance companies and credit corporate sales accounts. Also working to minimize the rejections and collect payments within due dates to improve polyclinic profitability.

 

 

 

 

 

 

 

Accountabilities :

Medical Insurance Senior Specialist

  • Medical Insurance Head Working on instant approvals for insurance guests, analyzing day-to-day data to improve the claiming process and operations.
  • Reviewing and verifying the claims and all the required data/information.
  • Verifying and checking the reports matching with “weasel” insurance companies’ systems (Tawuniya, DHS, and Bupa).
  • Communicating and negotiating with insurance companies in case of claims rejections to minimize it before reconciliations.
  • Experience with healthcare providers in insurance will be an added point.
  • Reviewing patient records using medical coding procedures.
  • Examine claims, verify insurance eligibility, and record any medical charges and other payments or adjustments.
  • Detecting any coding errors or performing any modifications needed.
  • Assisting patients in obtaining and understanding medical benefits.
  • Communication with other medical staff members and health insurance providers often occurs.
  • Responsible for updating any internal databases, which electronically store and organize patients’ records, billing details, and registration forms.
  • Liaise with concerned departments on their medical insurance claims and finalize them with other teams (Finance, IT..etc)

Employee’s duties are not limited only to the Accountabilities mentioned above; he/she may perform other duties as assigned.

Medical Insurance Senior Specialist

 

 

 

 

 

Work Environment :
  • Indoors: 100%
  • Outdoors                 : 0%
  • Working Days: 6 Working Days
  • Days off: 1 Day Off
  • Working Hours: 8 hours Shifts to ensure continuous attendance to reception. (with 1 hour Rota break)

 

 

 

 

 

Job Requirement :
Education
  • High School Diploma (Preferably University Graduate)
Experience
  • 2years in Medical Insurance
Computer Skills
  • Microsoft Office
Languages
  • English and Arabic (fluent spoken and written)

 

 

 

 

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Senior Executive Manager – Risk Management

Email
Job Description :

Senior Executive Manager – Risk Management

  • The Senior Executive Manager – Risk Management will manage risk management practices across Bupa Arabia and oversee the principles underpinning a robust and continuous Risk Management Framework in line with the Board’s Risk Appetite by designing, building, and operating a robust foundation to identify and understand the current and emerging risks to Bupa Arabia and their potential consequences

 

Governance :

Senior Executive Manager – Risk Management

  • Enact risk management practices in Bupa Arabia in sync with the Board’s overall responsibility for the oversight of risk, ensuring risk management activities are embedded including a risk management strategy, governance policies, and a risk assessment and reporting life cycle.
  • Partner with Bupa Arabia Risk Management Committee to play an active role in owning the whole Company’s risk profile and acting on risk themes holistically.

 

 

 

Risk Management :

Senior Executive Manager – Risk Management

  • Collaborate with Bupa Arabia’s Chief Executive Team to set a strong ‘’Tone from the Top’’ about Risk Management and have accountabilities for facilitating and supporting a strong culture for risk management.

 

 

Risk Strategy & Appetite :
  • Develop and own Bupa Arabia’s risk strategy, ensuring it is consistent with the delivery of business strategy over the business planning period and the expectations of stakeholders.

 

 

Policies & Risk Management Lifecycle :
  • Partner with Corporate Governance Department ensuring that Bupa Arabia Enterprise policies are maintained, and define the key principles and requirements for how risk is managed in Bupa Arabia.

 

 

 

Risk Management Framework :
  • Sponsor the adoption of a common Risk Management Framework across Bupa Arabia to support a consistent risk management approach. All the different areas of risk that Bupa Arabia is exposed to in the pursuit of its business objectives are categorized using a standard risk categorization model.

 

 

 

Incident Management :
  • Build the foundation and infrastructure for incidents to be identified, escalated, and reported in a timely fashion via defined governance routes including executive management and the relevant committees, depending on materiality and in line with the Critical Incident Policy.

 

 

 

Forward-Looking Assessment :
  • Advocate conducting a Bupa Arabia-wide Own Risk and Solvency Assessment (ORSA) in line with the prevailing ORSA Standard.
  • Direct Bupa Arabia’s ORSA conduct (or equivalent), in line with local regulatory requirements.

 

 

Management of Insurable Risks :
  • Assist CRO with directing the activities of the Insurance team, and provide advice and guidance as necessary.
  • Lead the management of international and nationwide Insurance programs, ensuring compliance with prevailing rules and regulations, including taxes.

 

 

 

Fraud Risk Management :
  • Design a robust Fraud Risk Management Framework in line with regulatory and risk management standards to enforce the zero tolerance approach against internal and external fraud & to continuously assess the framework.
  • Facilitate with Legal Affairs Department to ensure the effectiveness of the design and implementation of the Speak Up program, as a fraud detective tool.

 

 

 

Skills :

Years of Experience

  • Minimum 7 years of relevant experience

 

 

 

Skills Required :
  • General understanding of risk factors affecting insurance companies, familiarity with risk-oriented regulations (e.g. Solvency II).
  • Leadership skills, including the ability to manage risk, compliance, and control activities in a complex financial operation.
  • Considerable knowledge and experience of best practice risk management and governance frameworks, methodologies, and emerging practice.
  • Skilled communicator with the ability to influence and motivate others.
  • Ability to exercise oversight over governance, risk, compliance, and control arrangements, desirable in a complex financial operation.

 

 

 

Other Requirements :
  • University Degree. Master’s Degree and Insurance degree is preferred
  • Hold internationally accepted relevant certification
  • Professional Certificate(s) in insurance is preferred

أخصائي تأمين

الوصف الوظيفي :
 ملخص الوظيفة : Job Summary

أخصائي تأمين
  • رصد ومتابعة جميع حالات عملاء التأمين الصحي من وقت دخولهم للمدينة وأثناء تنويمهم وحتى خروجهم من تواصل مع شركات التأمين لطلب الموافقات على الخدمات والإجراءات المقدمة واحتساب الخدمات وإعداد المطالبات وفق سياسات وإجراءات المدينة وأنظمة ولوائح وزارة الصحة و مجلس الضمان الصحي التعاوني.

المتابعة اليومية للحالات مع شركات التأمين الصحي هي مهمة أساسية وركيزة في العمل اليومي لأخصائي التأمين الصحي.

 

  • الرصد والمتابعة اليومية المستمرة لحالات عملاء التأمين الصحي السعوديين وغير السعوديين مع مراعاة أن

تكون جميع الحالات قيد المتابعة المستمرة.

  • التواصل مع شركات التأمين الصحي التي يتبع لها العملاء عن طريق القنوات الرسمية لطلب الموافقات على

الخدمات الصحية المقدمة وتغطية تكاليفها وتحديثهم بحالة العميل والخدمات المقدمة مع مراعاة معايير

–  طلب الموافقة على تحمل تكاليف العلاج.

  • تزويد شركات التأمين الصحي بجميع المستندات الطبية أو المتطلبات والرد على استفساراتهم بأسرع وقت

ممكن مع الإستعانة بطبيب الضمان أو الطبيب المعالج.

  • إبقاء العميل على دراية بحالة طلبات الموافقة على الخدمات المقدمة.
  • التأكد من أنه تم احتساب جميع الخدمات المقدمة لعميل التأمين الصحي.
  • إعداد المطالبات متضمنة جميع متطلباتها ومستنداتها.
  • الإنتهاء من الحالات وإقفالها حسب المدة النظامية.
  • توثيق جميع عمليات متابعة الحالات باستخدام أنظمة المدينة الرسمية و المعتمدة.
  • إعداد تقرير تدون به كل طلبات الموافقات وما آلت إليه وإرساله للمشرف.
  • اتباع السياسات والإجراءات المبنية على قوانين وأنظمة ولوائح وزارة الصحة ومجلس الضمان الصحي التعاوني.
  • الحضور والمشاركة في اجتماعات القسم.
  • الإلتحاق بورش عمل ودورات تتعلق بمجال العمل.
  • القيام بأي مهام أخرى توكل من قبل الرئيس أو المشرف  المتعلقة بنطاق خدمة القسم

 

 

 

 

متطلبات الوظيفة :
المؤهلات والخبرة :
المؤهلات المطلوبة للوظيفة :

 

بكالوريوس إدارة مستشفيات او إدارة صحية

 

 

 

 

 

شهادة اختبار اللغة الانجليزية :
  • يرجى ملاحظة أنه لن يتم النظر في الطلب إذا لم تقم بإرفاق شهادة اختبار اللغة الانجليزية(IELTS,TOEFL,STEP) مع الحد الأدنى من الدرجات المعتمدة أدناه:
  • درجة البكالوريوس : IELTS – الحد الأدنى 5.0 أو STEP – الحد الأدنى 75 أو TOEFL IBT – الحد الأدنى 64.

 

 

الكفاءات  الفنية و السلوكية والمهارات :
الكفاءات والمهارات المطلوبة :
تحمل المسؤولية والحرص على فهم دوره في العمل ومشاركة التحديات بشفافية .
إدارة الفريق
العمل الجماعي
التواصل الفعال
الإلمام بالمصطلحات الطبية و المعرفة بالأسس والمفاهيم الفنية المتعلقة بالعمل.
حل المشكلات
إدارة الوقت
المبادرة وتقديم الأفكار والمقترحات.

 

 

@Careers56

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Senior Specialist – Claims Health

مسؤول مبيعات
Job Description :
OVERALL PURPOSE :

Senior Specialist – Claims Health

– The primary role of this position will be the Final Reconciliation of Provider accounts in compliance with technical, Contractual, and medical protocols, maintaining the provider profiles, and facilitating the Medical team internally with Provider trends & Externally with Providers with their Quality feedback. Help in maintaining the departmental claims production, whenever required.

Key Responsibilities :

Senior Specialist – Claims Health

– Responsible for the final Reconciliation of assigned providers, and accounts and achieved departmental targets.

– Analytical reporting for Medical utilization, treatment trends, & Management Patterns of assigned providers and facilitating the Reconciliation of Commercial executives to achieve the target PSE.

– Responsible for finalizing the claims payment for assigned providers within a defined period.

– Responsible for Health care providers profiling and focus billing trends of providers.

– Negotiation with Providers in getting special discounts on HV (Inpatient Claims) on Medical auditory feedback.

– Work on claims rejection summary and assist in maintaining the quality of the provider’s monthly statements.

– Work on the claims data and assist in analyzing and reporting the abusive and fraudulent behaviors and billing from providers.

– Assist in preparing the claims quality and rejections reports and help with re-work on re-submitted claims & generate the final provider statement.

– Periodically visit the providers to finalize the reconciliations & settlements.

– Support the departmental strategies & play a vital role in maintaining the Quality of Medical management from the provider’s side by giving regular feedback on claims and treatment quality.

– This job description contains the basic requirements for the position and is NOT intended to be a complete list of responsibilities.

Senior Specialist – Claims Health

Academic Qualifications and Experience :

– MBBS
– 4-5 Years Experience
– English Proficiency

Skills :

– MBBS
– 4-5 Years Experience
– English Proficiency

@Careers56

Careers56.com

Specialist – Claims Health

مسؤول مبيعات
Job Description :
OVERALL PURPOSE :

Specialist – Claims Health

– The primary role of this position will be to audit the outpatient health claims in compliance with technical, Contractual, and medical protocols, maintain the provider profiles, and facilitate the reconciliation unit with rejection data to achieve the department target.

– Help in maintaining the departmental claims production & Claims TAT.

Key Responsibilities :

Specialist – Claims Health

– Responsible for auditing or adjudicating the OP medical claims and playing a role in maintaining the unit production

– Responsible for Health care providers profiling and focus billing trends of providers.

– Work on claims rejection summary and assist in maintaining the quality of the provider’s monthly statements.

– Work on the claims data and assist in analyzing and reporting the abusive and fraudulent behaviors and billing from providers.

– Assist in preparing the claims quality and rejections reports and help the reconciliation unit to finalize the open account and final settlement with Providers.

– Support the departmental strategies & play a vital role in maintaining the Quality of Medical management from the provider’s side by giving regular feedback on claims and treatment quality.

– This job description contains the basic requirements for the position and is NOT intended to be a complete list of responsibilities.

Specialist – Claims Health

Academic Qualifications and Experience :

– Bachelor’s Degree in Nursing, Pharmacy, and Lab. Science, Microbiology.
– Fresh Graduate Or 1 to 2 Year Experience
– English Proficiency

Skills :

– Bachelor’s Degree in Nursing, Pharmacy, and Lab. Science, Microbiology.
– Fresh Graduate Or 1 to 2 Year Experience
– English Proficiency

@Careers56

Careers56.com

Specialist – Policy Issuance

مسؤول مبيعات
Job Description :
OVERALL PURPOSE :

Specialist – Policy Issuance

– Manage timely and accurate policy issuance process consistent with compliance and performance standards including changes/updating as per the guideline for Health Insurance

Key Responsibilities :

Specialist – Policy Issuance

– Issue policies according to company guidelines and procedures.

– Work directly with the sales team and underwriting team to modify, update, and process insurance policies

– Review and verify personal information including names, addresses, ages, assets, and other data to ensure the accuracy of insurance company records

– Complete record-keeping and data entry to maintain accurate client information

– Develop and maintain client, carrier, and agent relationships through timely, accurate service
Audit, correct, and verify all necessary information before policy issuance.

– Monitor accounts to ensure compliance with the company’s policies and procedures and take appropriate actions for corrections when necessary

– Request cancellation and reinstatement of policies based on the outlined terms of company policies and regulatory requirements

– Conduct ratings as necessary to ensure policy information is accurate.

– Maintain the suspense system and follow up on receipt of policy endorsement inspections correspondence

– Forward policy servicing inquiries from carrier requests to Quality Control for handling

Specialist – Policy Issuance

Academic Qualifications and Experience :

– Degree in Management/Accounting
– 1-2 Years of Experience
– English Proficiency

Skills :

– Degree in Management/Accounting
– 1-2 Years of Experience
– English Proficiency

@Careers56

Careers56.com