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Our office in Abu Dhabi is currently looking for Claims Processor with background in nursing.

Job Summary

  • The Claims Processor is responsible for claims processing of UAE and non-UAE markets.  This includes electronic claims, manual paper claims and reimbursement claims.
  • The claim processor is required to analyze a claim based on policy conditions, regulatory requirements, international medical guidelines and SAICOHEALTH internal process and procedures.

Responsibilities

  • Perform claims data entry and medical review
  • Adjudicate each claim and associated services based on coding rule (UAE market) and policy conditions that includes system driven eligibility checks, coding checks and perform medical necessity checks
  • Follow pre-approval protocols as per provider handbook
  • Ensure claims are accurately paid as per agreed tariff and apply proper reasonable and customary charges as per internal guidelines
  • Approve claims up to the assigned authority matrix
  • Coordinate with pre-approval team and network team on a case by case manner where relevant for the claims adjudication
  • Coordinate with providers in explaining the rejections on claims
  • Responsible for paper claims registration and reception desk as a back-up staff
  • Assist Team Leader and Operations Manager in enhancing and developing the process and system
  • Adhere to the contents of the Operating Procedures Manual (OPM) and the Company’s overall policies and procedures
  • Miscellaneous tasks within the scope of work, as assigned by the direct manager.

Education

  • Graduate in Medical Nursing.

Experience

  • 2 – 5 years experience in health insurance field

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Job Summary

The Account Executive – Brokers Relation is responsible for building and managing the relationship with the Brokers; the incumbent will produce revenue for the corporation and manage the accounts of the brokers.

Main functions and responsibilities:

  1. Develop and maintain the relationship with the Brokers in accordance with SAICO Strategy whilst ensuring compliance with local and International Regulations.
  2. Manage the relationship with the brokers to achieve monthly new business and renewal targets.
  3. Present recommendations to AVP Brokers Relations for approval.
  4. Maintain clear and accurate data in SAICO CRM.
  5. Identify potential areas of improvement related to the brokers’ service levels.
  6. Ensure quality & consistency across all brokers’ activities and recommend process improvement when needed.
  7. Assess and identify new markets’ potential.
  8. Report to the AVP Brokers Relations the performance of the Broker account against the set objectives and targets.
  9. Ensure Company core competencies, values, policies & procedures are implemented across the teams.
  10. Miscellaneous tasks within the scope of work, as assigned by the direct manager.

Technical Experience

  • 5 years of experience in similar job – Medical Insurance field

Education

  • Bachelors degree.

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Job Summary

To effectively manage the Sales Operations and Customer Support functions. To provide unparalleled service levels to internal and external stakeholders.

Main Responsibilities

  1. Handle daily sales operations, policy issuance and endorsement process for medical and general insurance.
  2. Manage, coach and appraise the sales support team.
  3. Coordinate with internal departments to ensure process alignment and to meet regulatory requirements.
  4. Work closely with IT department to ensure continual system enhancement and escalation of issues as well as automation of manual processes.
  5. Manage relationships with external vendors.
  6. Responsible for performing process related audits and the coordination with internal auditors.
  7. Develop monitoring reports and share with management to agree on corrective measures where required to ensure optimum service level for clients.
  8. Handle specific projects as assigned by the management.

Technical Experience

  • 5-7 years of experience in an insurance operation position.

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Job Summary

Performing motor claims surveys and processing claims accurately in the system.

Main Responsibilities 

1. Survey accident vehicles on a timely basis as requested by claims team in respect of vehicles belonging to the Insured or vehicles damaged due to accident caused by Insured.
2. Survey damages in relation to police report and any other information available.
3. Prepare survey reports in time and ensure they are complete in all respects so that correct documentation is available for the claim files.
4. Register claims in the core IT system and upload survey report and related documents for processing.
5. Appoint independent surveyor for disputed claims as and when necessary by following the correct procedures.
6. Negotiate discounts with dealers/workshops for vehicle repairs in the best interest of the Company with a view to reducing claims cost without compromising on the quality of repairs.
7. Assess and recommend constructive total loss of any vehicle in case of significant damages where repairs are likely to be uneconomical, based on nature/extent of damages and estimated salvage value.
8. Deal with salvage service providers and set realistic reserve price for salvage vehicles.
9. Directly communicate with customers on status of survey in coordination with the Claims team.
10. Ensure best practices and quality service while dealing with workshops, third party insurers, customers and claims team.
11. Adhere to the contents of the Operating Procedures Manual and the Company’s overall internal procedures and policies including claims procedures and guidelines.
12. Perform miscellaneous within the scope of work, as assigned by the direct manager.

 

Education

1. University Degree
2. Background in Automobile Engineering (Diploma or Degree)
3. Professional insurance qualification preferred
4. Bi-lingual (English & Arabic)
5. Enthusiastic, motivated and dedicated

 

Technical Experience

1. Minimum 5 years relevant work experience as motor claims surveyor in an insurance company

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Looking for your first job? You’ll be happy to know that we are recruiting fresh graduates’.

We at Damana, are hiring UAE nationals who have recently graduated and looking for entry level opportunities in Human Resources, Marketing / Corporate communications and Office Administration. The way we see it, it’s a great way to introduce you to the Insurance sector.

If you are interested in understanding the insurance sector and pursuing a career with us, send your CV to careers@damana.com and let’s discuss!“

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