JOB DESCRIPTION / ROLE
The main objective of this position is operating Benefits Services W.L.L effectively with same standards. This position is ideal for a person who can work independently, take initiative, prioritize, multitasks and follow-up as needed.
Main responsibilities/Tasks:
- Support Quality Assurance Manager in developing the processes needed for the Quality Assurance methodology to establish, implement and maintain across operations – Claims, Pre-authorization, Customer Service, Network Provider Relation, Billing, Eligibility, Compliance and Case Management;
- Engage and provide inputs for developing robust Quality Assurance methodology based on the business structure and requirements;
- Prepare and document escalation of critical issues to Quality Assurance Manager;
- Conduct on field Process Quality Assurance Reviews in line with the methodology and identify risks that impacts the business;
- Support and conduct reviews based on Internal Control / Operational Audits methodology;
- Responsible for preparation of Process workflow documentation and gap analysis;
- Actively participate in developing robust plans that mitigate internal and external compliance risks, identify improvement opportunities;
- Prepare, analyze and report Management Information data for consumption of senior management teams;
- Coordinate with internal stakeholders to achieve overall objective of the work;
- Support in significant improvement projects;
- Reviews the accuracy of case processing activities ( Claim Processing, Claim Payment, Approval Checking, Financial accuracy, , claim accuracy, Premium Collocation) , and data entry to ensure compliance and consistency with administrative procedures and guidelines;
- Support in developing various Key Performance Indicator and Metrics in the overall improvement of the process and engage in governance of the same;
- Recommend training requirement to manage and control error in each department ;
- Coordinate with line manager of each department and support them to decrease risk in each function in the department ;
- Develop weekly and monthly reports to management;
- Support manager in all ad-hoc activities including report writing, case investigations, MI data, Presentation, reporting etc;
REQUIREMENTS
- Bachelor’s Degree & Quality Audit;
- Good Knowledge of Insurance / TPA / and Reinsurance Company / claim / premium / medical insurance – Preferred not mandatory;
- Attention to detail and the determination on quality standards are essential;
- Ability to communicate effectively with key stakeholders at all levels within an organization;
Skill & Knowledge required:
- Experience in carrying out Quality Assurance Reviews / Internal Control Reviews / Operational Audit;
- Experience and knowledge of Management Information reporting and Presentation skills;
- Exceptional analytical skills and attention to detail together with strong ability to organize work and focus on delivering results.
- Project management & Excellent organizational skills.
- Audits work using analysis and interpretation and audits moderately complex work/products/processes.
- Pro-active, own initiative and accountability.
- Ability to deal with numerous tasks simultaneously.
- Demonstrated ability to build effective partnerships, and drive process implementation across organizational lines.
- Creative reporting skills
- Experience working in health insurance or third party administrative industry in a related role.
- Strong influencing skills and ability to work in a complex highly matrix environment, including balancing priorities of multiple organizations to deliver end results.
- Aware of Software Quality Management System (QMS).
Personal Competencies:
- Strong business sense
- Excellent interpersonal skills and outgoing, willingness to take charge
- Multi-Tasking
- Ability to organize, prioritize and plan
- Results-oriented
- Effective in verbal and written communication
- Mature with ability to effectively communicate and influence individuals at all levels.
- Energetic and enthusiastic
- Team Player
ABOUT THE COMPANY
Established in 1996, Clarendon Parker Bahrain is an International Recruitment Specialist Consultancy based in Bahrains Seef Business District. We specialise in mid to senior level professional, managerial, technical recruitment and staffing solutions in Bahrain and beyond. Our multinational team of consultants are experienced professionals within the fields they represent. Each consultant brings strong industry links and knowledge to better understand your business requirements. We know the market and we know our candidates!
Our team of dedicated consultants specialise in the following industries:
Accounting, Finance & Banking Logistics & Customer Service Secretarial & Administration Human Resources & Recruitment Engineering & Construction IT/Telecom Marketing & PR Oil and Gas
The current range of services includes permanent and temporary recruitment, recruitment advertising campaigns, employee satisfaction surveys, state-of-the-art web-based recruitment technology and HR consulting services relating to recruitment processes and activities.
