Medical Claims Manager - Corporate Insurance
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Key skills for this role
About the Role
Crossroads Insurance Brokers LLC seeks a Claims Manager to lead the Corporate Medical Claims function, acting as a bridge between clients, insurers, TPAs, and healthcare providers.
Key Skills for This Role
Responsibilities
- Manage and oversee all corporate medical insurance claims support activities
- Act as the primary escalation point for complex, delayed, disputed, or rejected claims
- Represent clients' interests and advocate for fair claim settlements with insurers and TPAs
- Facilitate resolution of reimbursement, pre authorization, inpatient, outpatient, maternity, dental, optical, and chronic care claims
- Ensure claims are managed within agreed service levels and client expectations
- Build and maintain strong relationships with corporate clients, HR teams, and key decision makers
- Conduct periodic claims review meetings with clients
- Provide guidance on policy benefits, exclusions, network utilization, and claims procedures
- Support Key Account Managers in enhancing client satisfaction and retention
- Address client concerns and complaints relating to medical claims and service delivery
- Liaise regularly with insurers, TPAs, hospitals, and healthcare providers to ensure smooth claims processing
- Escalate unresolved cases to senior insurer and TPA stakeholders
Requirements
- Experience in corporate medical insurance claims management
- Strong knowledge of medical insurance claims processes, including reimbursement, pre authorization, inpatient, outpatient, maternity, dental, optical, and chronic care claims
- Excellent client relationship management and advocacy skills
- Ability to manage escalations and resolve complex claims issues
- Experience in analyzing claims utilization and preparing claims experience reports
- Team leadership and mentoring experience
- Knowledge of UAE insurance regulations and compliance requirements
- Proficiency in Microsoft Excel and claims management systems
Full Job Posting
Position Summary
- The Claims Manager is responsible for leading the Corporate Medical Claims function of Crossroads Insurance Brokers LLC, ensuring exceptional claims support and advocacy for corporate clients.
- The role acts as a bridge between clients, insurers, TPAs, and healthcare providers to facilitate timely claim resolution, improve customer experience, and support client retention.
- The Claims Manager is responsible for managing escalations, analyzing claims trends, providing strategic claims insights during renewals, and ensuring service excellence across the corporate medical portfolio.
Key Responsibilities
- Manage and oversee all corporate medical insurance claims support activities.
- Act as the primary escalation point for complex, delayed, disputed, or rejected claims.
- Represent clients' interests and advocate for fair claim settlements with insurers and TPAs.
- Facilitate resolution of reimbursement, pre authorization, inpatient, outpatient, maternity, dental, optical, and chronic care claims.
- Ensure claims are managed within agreed service levels and client expectations.
- Build and maintain strong relationships with corporate clients, HR teams, and key decision makers.
- Conduct periodic claims review meetings with clients.
- Provide guidance on policy benefits, exclusions, network utilization, and claims procedures.
- Support Key Account Managers in enhancing client satisfaction and retention.
- Address client concerns and complaints relating to medical claims and service delivery.
- Liaise regularly with insurers, TPAs, hospitals, and healthcare providers to ensure smooth claims processing.
- Escalate unresolved cases to senior insurer and TPA stakeholders.
Compensation
- Pay: AED5,000.00 AED8,000.00 per month
Work Location
- In person
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