Assistant Claims Manager

MedNet Egypt is one of the leading managed care service organisations that cater to healthcare needs. We are looking for a skilled Assistant Manager - Claims who is responsible for Planning and managing the data entry and claims processing operations of MedNet UAE’s Top Insurer in order to ensure the delivery of high quality claims handling services to customers within the defined turnaround times (TAT) in accordance with established policies and corporate guidelines in order to support the achievement of revenue targets and overall business objectives.

Your Job:

• Manage claims processing operations for provider network claims, direct reimbursements, and re-submissions, ensuring efficiency and compliance with turnaround times (TAT).
• Oversee claims settlement as per financial authority levels and ensure proper reserve management.
• Ensure quality assurance through spot-checking and audits, ensuring claims are processed accurately and efficiently.
• Monitor technological system performance and coordinate with the IT department for system enhancements to improve operational efficiency.
• Lead and develop teams by setting objectives, providing coaching, and offering continuous training to maintain high performance.
• Act as an external auditor for high-value claims, ensuring compliance with internal policies before submission to the Hub Manager.
• Act as an Account Manager for primary insurance companies and groups, ensuring service delivery aligns with SLAs.
• Drive continuous improvement in claims processes, cost reduction strategies, and workflow optimisation.
• Ensure compliance with local health insurance laws, MedNet, and Munich Re policies.
• Supervise claims processing reports to support decision-making and ensure compliance with corporate standards.
• Coordinate with internal teams and external stakeholders (insurance partners, brokers, providers) for efficient claims handling.
• Implement process improvements to enhance operational effectiveness and service quality.

Your Profile

• Bachelor’s degree in Medicine, Pharmacy, or Dentistry.
• 5+ years of experience in medical claims management, with at least 2 years in a supervisory role.
• Strong knowledge of medical coding and claims processing procedures.
• Excellent time management and database management skills.
• Strong leadership and team management capabilities.
• Problem-solving and analytical thinking to improve claims operations.
• Customer-focused mindset with strong communication and stakeholder management skills.
• Ability to handle multiple priorities and work in a fast-paced environment.
• Proficiency in healthcare regulations and compliance standards