HEALTH INSURANCE MANAGER

“World leader in building materials, the company extracts resources from the heart of the earth to bring out materials to the heart of life. Present in 90 countries, the Group responds to the world's demand for housing and infrastructure. the company is driven by the needs of its customers, shareholders, local communities and architects. The Group creates specialist solutions which encourage creativity whilst leaving a lighter trace on the world.”

Overall Job Mission:

Manage medical and health services through Health Insurance Provider in compliance with
the internal Health insurance bi-laws, in order to ensure the delivery of the best health care
services as well as controlling optimizing the costs.

Scope of Work:

  • Establish and maintain an automated comprehensive health insurance
    management system that is considered data core for all beneficiaries
    including medical records, treatments and costs.
  • Control health insurance costs through continuous analysis and identifying
    the points of improvements, suggest solutions and control points.
  • Monitor Health Insurance Provider to ensure provision of the best health
    services to beneficiaries, by coordinating with the different related
    departments (processing, PMC approval department and medical network),
    and with the medical service providers.
  • Conduct regular auditing of health insurance medical claims provided by
    health insurance Provider, in order to emphasize quality, accuracy and
    compliance with patient records and implement corrective actions as
    necessary.
  • Monitor and identify misuse of health insurance benefits by both
    beneficiaries and health care providers, perform regular analytical reports in
    order to determine the points of misuse and take the appropriate Corrective
    actions.
  • Manage the process of health insurance deductible (Co-insurance value and
    debits relative to uncovered treatments).
  • Prepare and manage the annual budget of health insurance department.
    Review, approve, allocate invoices and handle expense reports and actuarial
    analysis with continuous initiatives, to minimize financial expenses.
  • Manage the process of requesting health insurance quotations, leading the
    negotiations of the provided health coverage; benefits, limitations and
    exclusions.
  • Follow up on retired beneficiary’s financial balances and subscriptions.
    Analyze statistical data, such as mortality, accident, sickness, disability, and
    retirement rates and report any significant findings to management.
  • Manage the medical staff, inventory supplies (Medical equipments &
    medication), and the purchase of medications at the clinics at different sites.

Job Details

Posted Date: 2018-10-20
Job Location: Amman, Jordan
Job Role: Medical, Healthcare, and Nursing
Company Industry: Manufacturing and Production

Preferred Candidate

Career Level: Mid Career
Degree: Bachelor's degree

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