Specialist, Medical Insurance Administration III

Position Overview

We are seeking a highly organized and detail-oriented Specialist, Medical Insurance Administration III to oversee and streamline our employee medical insurance programs, work injury processes, and healthcare coordination initiatives. In this pivotal role, you will ensure seamless administration of medical benefits, compliance with regulatory standards, and exceptional support for employees’ healthcare needs. Your expertise will be instrumental in maintaining accurate records, processing claims efficiently, and fostering strong relationships with healthcare providers and regulatory bodies. If you are passionate about healthcare administration and committed to delivering excellence in employee benefits management, we invite you to join our dynamic team.

Key Responsibilities

The Specialist, Medical Insurance Administration III will play a critical role in managing and administering our medical insurance and healthcare services. Your core responsibilities will include:

• Insurance Program Administration: Oversee the administration of employee medical insurance programs in strict compliance with Health Insurance Council (CHI) regulations, ensuring all processes align with legal and company standards.
• Claims Management: Review, validate, and process employee medical expense claims in accordance with established policies, ensuring accuracy and timely resolution to support employee well-being.
• Regulatory Compliance: Manage GOSI registration, reporting, and follow-up for work-related injury cases, ensuring adherence to national occupational health and safety regulations.
• Healthcare Coordination: Coordinate pre-employment medical examinations for new hires and facilitate medical travel arrangements for employees requiring specialized treatment within or outside the Kingdom, ensuring seamless access to quality healthcare.
• Provider Management: Evaluate and maintain the quality of healthcare providers, including company clinics and external medical facilities, through regular site visits and compliance monitoring to uphold service excellence.
• Employee Support: Serve as a primary point of contact for employees’ medical insurance inquiries, providing clear guidance and resolving issues to enhance their overall experience and satisfaction.
• Record Maintenance: Ensure the accuracy and confidentiality of medical insurance and employee healthcare records, adhering to data protection and compliance requirements.

Qualifications and Experience

To excel in this role, you will bring the following qualifications and experience:

• Education: A Bachelor’s degree in Healthcare Administration, Business Administration, Human Resources, or a related field is required.
• Experience: A minimum of two years of hands-on experience in medical insurance administration, healthcare services, employee medical support, or a closely related healthcare discipline is essential.
• Technical Skills:
  • Proficiency in managing the GOSI platform and navigating Health Insurance Council (CHI) regulations.
  • Strong working knowledge of medical terminology and insurance coordination processes.
  • Familiarity with the hospital and healthcare industry, including provider management and service standards.
  • Advanced proficiency in Microsoft Office Suite (Excel, Word, PowerPoint, Outlook) for data analysis, reporting, and communication.
• Soft Skills:
  • Exceptional communication and stakeholder management abilities to liaise with employees, healthcare providers, and regulatory authorities.
  • Analytical thinking and problem-solving skills to address complex medical insurance and healthcare-related challenges.
  • Strong time management, planning, and organizational capabilities to prioritize tasks and meet deadlines in a fast-paced environment.
  • Fluency in English, with the ability to articulate information clearly and professionally.

Core Competencies

The ideal candidate will demonstrate the following competencies to thrive in this role:

• Teamwork: Collaborate effectively with cross-functional teams to ensure cohesive and efficient healthcare administration.
• Integrity: Uphold ethical standards and maintain confidentiality in all aspects of medical insurance and employee healthcare management.
• Care: Exhibit empathy and dedication in supporting employees’ medical needs and well-being.
• Ownership: Take responsibility for your work, decisions, and outcomes, driving continuous improvement in processes and services.
• Communication: Articulate ideas clearly and listen actively to foster understanding and resolve inquiries efficiently.
• Accountability: Ensure compliance with policies, regulations, and company standards while delivering measurable results.
• Customer Focus: Prioritize employee satisfaction by providing responsive and high-quality support in all healthcare-related interactions.
• Analytical Thinking: Leverage data and insights to identify trends, resolve issues, and optimize medical insurance administration.
• Problem Solving: Address challenges proactively and implement effective solutions to enhance operational efficiency and employee experience.
• Planning and Organizing: Manage multiple priorities and deadlines with precision to maintain seamless healthcare coordination.
• Service Excellence: Deliver exceptional service to employees, healthcare providers, and stakeholders through consistent professionalism and attention to detail.