Qureos Mentor

Al Etihad Cooperative Insurance Co

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   Review claims according to the approved authority, verify fraud indicators, and take regulatory actions.
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   Monitor updates on fraud indicators and methods and inform the Claims Manager and Department Managers accordingly.
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   Review the drafting of letters and correspondence addressed to relevant authorities and approve them before being sent by department employees.
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   Review fraud indicators periodically (at least quarterly) and raise awareness among claims employees through awareness emails or workshops in coordination with the director of Claims.
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   Follow up on daily automated escalation reports and ensure that the regulatory timeframes for processing claims are not exceeded or extend the processing period of claims as per the policies and procedures manual.
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   Verify that the team complies with validating claims within the regulatory timeframes and according to the approved claims management policies and procedures manual.
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   Conduct weekly follow-up on pending claims with the entities contacted to verify the validity of claims or amend liability percentages, ensuring that regulatory processing timeframes are not exceeded without taking action to extend the claim processing period.
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   Supervise the team and ensure no discrimination in assigning tasks, authorities, or responsibilities.
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   Supervise the team to ensure the detection and reporting of fraud cases at no less than 5% of the annual net payments.
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   Verify that the team complies with notifying the section Claims Managers upon receiving a response from contacted entities within a maximum of one day from the date of receiving the response or decision, via email, and updating the system accordingly.
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   Randomly select samples of all claims paid and pending by the department for internal review of the procedures applied, ensuring that the sample is no less than 5% of the total paid claims, and record all observations in an official report submitted monthly to the General Manager of Claims.
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   If observations are detected that indicate a possible collusion or involvement of a Claims Department employee in fraudulent cases, or the leakage of critical information that contributes to such cases, a report must be submitted on the case and the suspected employee, supported with evidence, to the director of Motor Claims.
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  <li>
   Submit monthly reports to the General Manager of Claims on all claims assigned to the team, as well as a report on cases where fraudulent indicators were detected and proven.
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Legal Follow Up Team Supervisor

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Al Etihad Cooperative Insurance Co

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Legal Follow Up Team Supervisor