Location: Dubai International Airport, Dubai, United Arab Emirates (UAE)
Reports to: Senior Human Resources Manager – Compensation & Benefits.
Key Duties and Responsibilities:
Ensure seamless administration of EKFC’s medical benefits and implement process, procedures and controls covering all areas of medical activity so that all relevant procedural requirements are fulfilled while delivering a quality, cost-effective service.
Review and evaluate vendor performance against benchmarks/ established performance standards and ensure timely development of performance reports in order to keep the leadership team informed about performance while recommending areas of improvement to enhance service levels and customer experience.
Conduct customer satisfaction surveys for scheme member, meet with service providers to monitor and evaluate satisfaction levels and report on performance to Management with recommendation on areas of service enhancement to facilitate achievement of EKFC’s medical objectives.
Organise prevention/wellness programmes for members in accordance with defined requirements to facilitate awareness of quality health care initiatives across EKFC.
Conduct presentations for appointed health care provider staff on EKFC’s medical policies & managed care concepts.
Review and monitor initiatives (ex. mystery shopping etc.) to facilitate optimum control of fraud and abuse of the health care benefits and report on critical issues to Sr. Manager – C&B.
Review and update training material for training sessions for appointed health care provider staff on EKFC’s medical policies & managed care concepts. Train and provide updates to onsite clinic provider, on all related procedures in order to ensure awareness of EKFC’s service requirements and policies.
Develop a strong and effective network across industry to understand the latest trend of health care initiatives in order to facilitate enhancements/improvements in the current scheme offering. This will promote EKFC as employer of choice
Conduct cost-benefit analyses for investments such as preventive health care solutions, case management etc. in order to optimise investments/costs and to provide valued added benefits.
Prepare and interpret reports related to medical operations in a timely and accurate manner to meet EKFC policies and standards, and department requirements.
Conduct trend analysis to identify claims trend, behaviour trend etc. and report with recommendations to senior management for decision making.
Develop and maintain monthly statistical reports to facilitate benchmarking and the performance management of EKFC’s medical scheme for management decision making.
Prepare and recommend the medical scheme budget and monitor financial performance versus the budget so that the EKFC is aware of anticipated costs and areas of unsatisfactory performance are identified, rectified promptly and potential performance improvement opportunities are capitalised upon.
Proactively audit overseas claims and IP claims to ensure accurate application of agreed tariff of the providers, schedule of benefits, correct allocation of benefits, observance of policy limits and adherence to claims submission protocols are maintained accurately.
Gather feedback from employees to ensure high quality of customer service is offered by TPA & Clinic provider.
Qualifications, Skills and Experience:
The applicant must hold a Bachelor’s degree- Preferably in Healthcare science
Six years of experience in the field of Medical Insurance
Experience in managing health care clinics – Preferred
Extensive understanding of ICD 10 codes - Preferred
Familiarity with private and government health care delivery systems and insurance programs.
Knowledge of basic medical terminology and knowledge of legal aspects of medical records
Ability to write clear, concise narrative and statistical reports, effective communication skills and ability to present reports
About Emirates Group: The Emirates Group is a Dubai-based international aviation holding company headquartered in Garhoud, Dubai, United Arab Emirates, near Dubai International Airport. The Emirates Group comprises Dnata, an aviation services company providing ground handling services at 17 airports, and Emirates Airline, the largest airline in the Middle East. Emirates Airlines flies to over 140 destinations across 6 continents, operating a fleet of over 250 wide-bodied aircraft. The airline has 170 aircraft on order worth US$58 billion.