insurance claims supervisor

Aspris

<div>Job Purpose: 
The Insurance Supervisor is responsible for overseeing the daily operations of the insurance team, ensuring the effective management of insurance processes, and providing leadership and guidance to a team of insurance professionals. This role involves supervising insurance claims, policy administration, and customer service, while ensuring compliance with company policies, industry standards, and legal regulations.
1.Team Leadership &amp; Supervision: 
o Supervise and manage a team of insurance team at any site in UAE. 
o Provide guidance and training to ensure team members are well-versed in insurance processes, policies, and regulations. 
o Conduct performance evaluations and manage staff development, including providing feedback, setting goals, and identifying growth opportunities. 
o Handle day-to-day team operations, assigning tasks, monitoring performance, and ensuring productivity and quality standards are met. 
2. Insurance Claims 
o Oversee the processing and adjudication of insurance claims, ensuring that all claims are handled in a timely, efficient, and compliant manner. 
o Review files and policies, ensuring that coverage meets patients&rsquo; needs and company standards. 
o Manage the approval process, submission and resubmission of claims 
o Ensure accurate documentation and record-keeping for all insurance transactions. 
3.Customer Service &amp; Client Interaction: 
o Act as a point of escalation for customer issues or complaints related to insurance claims or policies. 
o Ensure excellent customer service is provided by the team, ensuring client satisfaction and retention. 
o Assist in responding to client inquiries, explaining policy terms, and resolving coverage-related issues.
Compliance &amp; Risk Management: 
o Ensure that insurance practices adhere to regulatory standards, internal policies, and industry best practices. 
o Monitor and ensure compliance with legal requirements, such as the accuracy of policy documentation, and file submissions. 
o Work with the risk management team to identify and mitigate potential risks and liabilities. 
5. Reporting &amp; Documentation: 
o Maintain accurate records of all insurance-related activities, ensuring proper documentation for audits and reviews. 
o Generate regular reports for upper management regarding claims performance, team productivity, and customer satisfaction. 
o Ensure all policies are accurately updated and renewed within required timelines. 
6. Process Improvement: 
o Identify opportunities for process improvements within the insurance department to increase efficiency and reduce errors. 
o Implement new tools, technologies, or systems to streamline operations and improve the customer experience.
<div>Knowledge / Education / Skills 
<ul><li>Bachelor&rsquo;s degree in business administration, Insurance, Finance, or a related field (preferred).</li><li>3-5 years of experience in the insurance industry, with at least 1-2 years in a supervisory role.</li></ul></div>
<ul><li>Coding exposure/knowledge</li><li>Strong knowledge of insurance policies, claims processing, and regulations.</li><li>Excellent leadership, communication, and interpersonal skills.</li><li>Ability to analyze and solve problems quickly and effectively.</li><li>Proficient in Microsoft Office Suite and insurance management software</li><li>Detail-oriented with strong organizational skills.</li><li>Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service.</li></ul></div>

Insurance Supervisor

Transguard Workforce Solutions

<div>
 
 
 Transguard Workforce Solutions
 
 is the UAE&rsquo;s leading provider of unique and innovative HR solutions. With a decade of experience in the region and a team that possesses extensive knowledge of the market, we provide a fully integrated HR solution.
 
 
 We are currently recruiting a
 
 Supervisor &ndash; Engineering &amp; Liabilities Claims (Non-Marine &amp; Energy)
 
 for our client based in Abu Dhabi, UAE.
 
 
 
 
 
 
 Job Purpose:
 
 
 
 The job holder is responsible for supervising and implementing claims management strategies for Engineering &amp; Liabilities Claims (Non-Marine &amp; Energy - Direct). This includes overseeing a team of senior officers to ensure claims are processed promptly, accurately, and in compliance with insurance policies, company standards, and regulatory guidelines.
 
 
 
 
 
 
 Job Responsibilities:
 
 
 
 
 1.Policy &amp; Compliance:
 
 
 <ul>
 <li>
 Review and recommend updates to claims policies and procedures.
 </li>
 <li>
 Ensure compliance with rules, regulations, and procedural requirements.
 </li>
 <li>
 Communicate policies and procedures effectively across the team.
 </li>
 </ul>
 
 
 2.Claims Operations:
 
 
 <ul>
 <li>
 Supervise claim registration, processing, and reserve creation.
 </li>
 <li>
 Review claims processed by senior officers for accuracy in deductibles and limits.
 </li>
 <li>
 Evaluate survey reports and assessments.
 </li>
 <li>
 Ensure timely and accurate responses to claims queries within SLA timelines.
 </li>
 <li>
 Monitor claim documentation, investigation, evaluation, negotiation, reserving, and settlement.
 </li>
 <li>
 Analyze claim trends and support strategy development to address adverse patterns.
 </li>
 <li>
 Support litigation processes and draft legal correspondence when required.
 </li>
 <li>
 Maintain and update physical and electronic claim files.
 </li>
 <li>
 Review and validate settlement payments and denials.
 </li>
 <li>
 Ensure timely reporting to management and internal stakeholders.
 </li>
 <li>
 Conduct claims ageing analysis and monitor unsettled claims.
 </li>
 <li>
 Manage external loss adjusters and surveyors.
 </li>
 <li>
 Support training and development initiatives within the team.
 </li>
 </ul>
 
 
 3.Claims Rejection &amp; Investigation:
 
 
 <ul>
 <li>
 Review declined claims and ensure proper communication with clients/brokers.
 </li>
 <li>
 Investigate complex and suspicious claims and provide recommendations.
 </li>
 <li>
 Ensure technical justification for all claim rejections.
 </li>
 <li>
 Implement dual-check processes within the team.
 </li>
 </ul>
 
 
 4.Continuous Improvement:
 
 
 <ul>
 <li>
 Identify opportunities for process and system improvements.
 </li>
 <li>
 Support development of tools for efficient claims settlement.
 </li>
 <li>
 Align improvements with market needs and approved strategies.
 </li>
 </ul>
 
 
 5.Customer Satisfaction:
 
 
 <ul>
 <li>
 Ensure high standards of customer service.
 </li>
 <li>
 Address claim-related queries promptly to enhance client satisfaction.
 </li>
 </ul>
 
 
 
 
 
 Key Performance Indicators (KPIs):
 
 
 <ul>
 <li>
 Adherence to Turnaround Times (TATs)
 </li>
 <li>
 Nil actionable or aged claims
 </li>
 <li>
 Increased claims settlement and recovery ratios
 </li>
 <li>
 Reduced excess payouts and erroneous payments
 </li>
 <li>
 Improved response times and reduced customer complaints
 </li>
 <li>
 Effective performance monitoring of loss adjusters/surveyors
 </li>
 <li>
 Successful implementation of process improvements
 </li>
 </ul>
 
 
 
 
 
 Job Requirements:
 
 
 <ul>
 <li>
 Bachelor&rsquo;s Degree in relevant field
 </li>
 <li>
 Native Arabic Speakers required
 </li>
 <li>
 Diploma in Insurance or relevant certification - preferred
 </li>
 <li>
 4&ndash;5 years of relevant experience in Engineering &amp; Liabilities Claims, including 2-4 years in a supervisory role
 </li>
 </ul>
 
 
</div>

Supervisor – Engineering & Liabilities Claims (Non-Marine & Energy)

Aspris by alkalma

Team Leadership &amp; Supervision:
<ul>
<li>Supervise and manage a team of insurance team at any site in UAE.</li>
<li>Provide guidance and training to ensure team members are well-versed in insurance processes, policies, and regulations.</li>
<li>Conduct performance evaluations and manage staff development, including providing feedback, setting goals, and identifying growth opportunities.</li>
<li>Handle day-to-day team operations, assigning tasks, monitoring performance, and ensuring productivity and quality standards are met.</li>
</ul>
Insurance Claims
<ul>
<li>Oversee the processing and adjudication of insurance claims, ensuring that all claims are handled in a timely, efficient, and compliant manner.</li>
<li>Review files and policies, ensuring that coverage meets patients needs and company standards.</li>
<li>Manage the approval process, submission and resubmission of claims</li>
<li>Ensure accurate documentation and record-keeping for all insurance transactions.</li>
</ul>
Customer Service &amp; Client Interaction:
<ul>
<li>Act as a point of escalation for customer issues or complaints related to insurance claims or policies.</li>
<li>Ensure excellent customer service is provided by the team, ensuring client satisfaction and retention.</li>
<li>Assist in responding to client inquiries, explaining policy terms, and resolving coverage-related issues.</li>
</ul>
Compliance &amp; Risk Management
<ul>
<li>Ensure that insurance practices adhere to regulatory standards, internal policies, and industry best practices.</li>
<li>Monitor and ensure compliance with legal requirements, such as the accuracy of policy documentation, and file submissions.</li>
<li>Work with the risk management team to identify and mitigate potential risks and liabilities.</li>
</ul>
Reporting &amp; Documentation:
<ul>
<li>Maintain accurate records of all insurance-related activities, ensuring proper documentation for audits and reviews.</li>
<li>Generate regular reports for upper management regarding claims performance, team productivity, and customer satisfaction.</li>
<li>Ensure all policies are accurately updated and renewed within required timelines.</li>
</ul>
Process Improvement:
<ul>
<li>Identify opportunities for process improvements within the insurance department to increase efficiency and reduce errors.</li>
<li>Implement new tools, technologies, or systems to streamline operations and improve the customer experience.</li>
</ul>

Mace

<div>
 Mace combines construction expertise with consultancy to unlock potential in every person or project and redefine the boundaries of ambition. Our values shape the way we consult and define the people we want to join us on our journey.
 
 
 
 The Project
 
 
 
 This is an opportunity to work on one of the largest programmes in Saudi Arabia. This unique project consists of major mixed-use development including sports facilities, entertainment, and arts along with all associated infrastructure.
 
 
 Mace is one of the delivery partners requiring high-calibre and experienced professionals to lead integrated teams throughout each phase of the project.
 
 
 Mace is currently providing programme management and looking for high-calibre, experienced professionals to lead integrated teams throughout each phase of the project.
 
 
 
 You&rsquo;ll Be Responsible For
 
 
 
 <ul>
 <li>
 Providing subject matter expertise in all aspects of claims management.
 </li>
 <li>
 Managing and maintaining comprehensive claims documentation within the contract administration software.
 </li>
 <li>
 Directing all claims and change management with respect to clients, project COS and third-party claims.
 </li>
 <li>
 Investigating, evaluating, and providing recommendations for the settlement of claims.
 </li>
 <li>
 Providing detailed evaluation of potential claim impact to the project management team.
 </li>
 <li>
 Improving systems, processes and service delivery.
 </li>
 <li>
 Establishing structures and tools to support area plans and strategic outcomes.
 </li>
 <li>
 Driving continuous improvement and identifying business enhancements.
 
 
 </li>
 </ul>
 
 You&rsquo;ll Need To Have
 
 
 
 <ul>
 <li>
 Necessary visa criteria for the Kingdom of Saudi Arabia and have relevant work experience working on high valued projects/ programmes for a project management consultancy business, which are required for immigration and client approval.
 </li>
 <li>
 Relevant MEA experience.
 </li>
 <li>
 Degree qualification.
 </li>
 <li>
 Chartered or relevant certifications such as MRICS or CIPS.
 </li>
 <li>
 Proven experience in working with delay claims, productivity claims, acceleration and extensions of time.
 
 
 </li>
 </ul>
 
 Our values
 
 
 
 
 Safety first - Going home safe and well:
 
 We champion a safe, diverse and inclusive working environment, understanding the importance of wellbeing in every team.
 
 
 
 Client focus - Deliver on our promise:
 
 We own the quality of deliverables, strategic outcomes and build long term relationships with our clients.
 
 
 
 Integrity - Always do the right thing:
 
 We influence positive outcomes within our industry, while always aligning with our compliance obligations.
 
 
 
 Create opportunity - For our people to excel:
 
 We champion a continuous improvement culture throughout all activities, inspiring our people and teams to develop.
 
 
 Mace is an inclusive employer and welcomes interest from a diverse range of candidates. Even if you feel you do not fulfil all the criteria, please apply as you may still be the best candidate for this role or another role within our organisation.
 
 
 We are also open to discussing part time, flexible, and hybrid working options if suitable with-in the role
 
 
</div>

Associate Director, Commercial Claims

NMC Health plc

<div><div>Claims Processing Team: Submission
 
<ul><li>Verifies the ICD1O CM codes and relevant CPT/ HCPCS codes on the UCF / discharge summary for submission to various insurance companies on day-to-day basis.
</li><li>Analysis of the UCF documentation issue from time to time and providing reports about areas of concern in coding and the claims.
</li><li>Uploads OP E-claims.
</li><li>Identifies commonly used ICD codes and relevant CPT codes and compile the list.
</li><li>Identifies the ICD codes (Diagnosis under Exclusion) and CPT codes (not billable).
</li><li>Reports variations / irrelevance in the CPT codes used for services/procedures.
</li><li>Assigns proper CPT/ HCPCS codes for newly added services / procedures.
</li><li>Reports the audit findings about discrepancies in the claims daily.
</li><li>Be available to the Consultants about clarification regarding the ICD/ CPT codes.
</li><li>Coordinates with Insurance Doctors and Billing Supervisor/ Accountants for E claim Submission, Resubmission, Follow Up and Final Sign off.
</li></ul>Claims Processing Team: Resubmission
 
<ul><li>Coder is required to review documentation by the physicians in the UCF / E &ndash; Discharge summary and look for discrepancies between the documentation and the coded, diagnosis and selected CPT codes.
</li><li>Senior Coder required to overview the notes prepared for UCF / Discharge Summary have all the required information. In case any information is missing they need to contact the physician and get it filled.
</li><li>Be available to the Consultants about any clarification regarding ICD/CPT codes.
</li><li>Senior Coder is required to speak to clinicians about specialty specific rejections and reasons for the rejections and how to avoid such rejections.</li></ul></div></div>
 <div><div>Claims Processing Team: Submission
 
<ul><li>Verifies the ICD1O CM codes and relevant CPT/ HCPCS codes on the UCF / discharge summary for submission to various insurance companies on day-to-day basis.
</li><li>Analysis of the UCF documentation issue from time to time and providing reports about areas of concern in coding and the claims.
</li><li>Uploads OP E-claims.
</li><li>Identifies commonly used ICD codes and relevant CPT codes and compile the list.
</li><li>Identifies the ICD codes (Diagnosis under Exclusion) and CPT codes (not billable).
</li><li>Reports variations / irrelevance in the CPT codes used for services/procedures.
</li><li>Assigns proper CPT/ HCPCS codes for newly added services / procedures.
</li><li>Reports the audit findings about discrepancies in the claims daily.
</li><li>Be available to the Consultants about clarification regarding the ICD/ CPT codes.
</li><li>Coordinates with Insurance Doctors and Billing Supervisor/ Accountants for E claim Submission, Resubmission, Follow Up and Final Sign off.
</li></ul>Claims Processing Team: Resubmission
 
<ul><li>Coder is required to review documentation by the physicians in the UCF / E &ndash; Discharge summary and look for discrepancies between the documentation and the coded, diagnosis and selected CPT codes.
</li><li>Senior Coder required to overview the notes prepared for UCF / Discharge Summary have all the required information. In case any information is missing they need to contact the physician and get it filled.
</li><li>Be available to the Consultants about any clarification regarding ICD/CPT codes.
</li><li>Senior Coder is required to speak to clinicians about specialty specific rejections and reasons for the rejections and how to avoid such rejections.</li></ul></div></div>
 <div>Bachelor. Diploma, High School</div>

RCM Administrator - UAE National

<div><div>Claims Processing Team: Submission
 
<ul><li>Verifies the ICD1O CM codes and relevant CPT/ HCPCS codes on the UCF / discharge summary for submission to various insurance companies on day-to-day basis.
</li><li>Analysis of the UCF documentation issue from time to time and providing reports about areas of concern in coding and the claims.
</li><li>Uploads OP E-claims.
</li><li>Identifies commonly used ICD codes and relevant CPT codes and compile the list.
</li><li>Identifies the ICD codes (Diagnosis under Exclusion) and CPT codes (not billable).
</li><li>Reports variations / irrelevance in the CPT codes used for services/procedures.
</li><li>Assigns proper CPT/ HCPCS codes for newly added services / procedures.
</li><li>Reports the audit findings about discrepancies in the claims daily.
</li><li>Be available to the Consultants about clarification regarding the ICD/ CPT codes.
</li><li>Coordinates with Insurance Doctors and Billing Supervisor/ Accountants for E claim Submission, Resubmission, Follow Up and Final Sign off.
</li></ul>Claims Processing Team: Resubmission
 
<ul><li>Coder is required to review documentation by the physicians in the UCF / E &ndash; Discharge summary and look for discrepancies between the documentation and the coded, diagnosis and selected CPT codes.
</li><li>Senior Coder required to overview the notes prepared for UCF / Discharge Summary have all the required information. In case any information is missing they need to contact the physician and get it filled.
</li><li>Be available to the Consultants about any clarification regarding ICD/CPT codes.
</li><li>Senior Coder is required to speak to clinicians about specialty specific rejections and reasons for the rejections and how to avoid such rejections.</li></ul></div></div>
 <div><div>Claims Processing Team: Submission
 
<ul><li>Verifies the ICD1O CM codes and relevant CPT/ HCPCS codes on the UCF / discharge summary for submission to various insurance companies on day-to-day basis.
</li><li>Analysis of the UCF documentation issue from time to time and providing reports about areas of concern in coding and the claims.
</li><li>Uploads OP E-claims.
</li><li>Identifies commonly used ICD codes and relevant CPT codes and compile the list.
</li><li>Identifies the ICD codes (Diagnosis under Exclusion) and CPT codes (not billable).
</li><li>Reports variations / irrelevance in the CPT codes used for services/procedures.
</li><li>Assigns proper CPT/ HCPCS codes for newly added services / procedures.
</li><li>Reports the audit findings about discrepancies in the claims daily.
</li><li>Be available to the Consultants about clarification regarding the ICD/ CPT codes.
</li><li>Coordinates with Insurance Doctors and Billing Supervisor/ Accountants for E claim Submission, Resubmission, Follow Up and Final Sign off.
</li></ul>Claims Processing Team: Resubmission
 
<ul><li>Coder is required to review documentation by the physicians in the UCF / E &ndash; Discharge summary and look for discrepancies between the documentation and the coded, diagnosis and selected CPT codes.
</li><li>Senior Coder required to overview the notes prepared for UCF / Discharge Summary have all the required information. In case any information is missing they need to contact the physician and get it filled.
</li><li>Be available to the Consultants about any clarification regarding ICD/CPT codes.
</li><li>Senior Coder is required to speak to clinicians about specialty specific rejections and reasons for the rejections and how to avoid such rejections.</li></ul></div></div>
 <div>Bachelor/Diploma/High School</div>

RCM Officer - UAE National

Safe-Guard Products International, LLC

<div>Please do not respond to direct messages with your personal information. All job applications and your sensitive, personal information should only be submitted via our official job platform.
Job Title Escalations Agent (hybrid)
Location: US-GA-Atlanta (Sandy Springs)
FLSA: Non-exempt
#LI-hybrid
Job Overview:
Provides support to agents, clients, and customers by adjudicating claims, providing claim&rsquo;s status, and resolving escalated customer/dealer issues. Communicates effectively with all levels of the organizations. In executing the duties of the role, Escalations Agents will ensure the proper documentation, adjudicate per the terms and conditions of the contract, utilizing available resources, and meet schedule expectations informing management of any changes.
Job Responsibilities:<ul><li>
Handles claims related inquiries per work schedule performing within defined metrics.</li><li>
May have to order an inspection when claim is over a certain amount or possible fraud.</li><li>
Follows proper claims procedures as outlined in training and feedback provided by QA or Supervisor.</li><li>
Extensive knowledge of all T+W contracts</li><li>
Master understanding of clients, agents, and contract terms and conditions.</li><li>
Understand Exceptions based upon dealership, agent, or client.</li><li>
Support other team members in assisting customers when situation requires involvement.</li><li>
Escalates &ldquo;Hot Issues&rdquo; to team lead, supervisor, or managers when unable to resolve satisfactorily.</li><li>
Notify Supervisor of any claims in which possible fraud is suspected.</li><li>
Participates in all training as required to perform the duties of the role.</li><li>
Takes initiative to resolve an issue rather than allow an issue to continue.</li><li>
Performs other related duties as required and/or assigned.</li><li>
Saturday Rotation</li><li>
Must be able to work a flexible schedule</li></ul>
The above statements are intended only to describe the general nature of the job and should not be construed as an all-inclusive list of position responsibilities.
Job Requirements:<ul><li>
High School Diploma or equivalent combination of education and experience required. College degree preferred.</li><li>
Minimum of three years&rsquo; experience in customer service, insurance claims, call/claims center environment. Experience within Automotive Industry preferred.</li><li>
Must be employed with Safe-Guard for 1 year</li><li>
Must have strong computer skills and the ability to troubleshoot and service policy issues.</li><li>
Must be proficient in Windows and MS-Office Products.</li><li>
Strong analytical and problem-solving skills. Superior verbal/written skills and communications skills.</li><li>
Good punctuation, spelling, mathematical, grammar and attention to detail a must.</li><li>
Strong interpersonal skills essential. Exercises sound judgment when interacting with customers.</li></ul>
Company Benefits:<ul><li>
Medical, Dental, and Vision Insurance</li><li>
Flexible Spending Account</li><li>
Health Savings Account</li><li>
401(k) Plan with Company Match</li><li>
Company-paid Short-Term and Long-Term Disability</li><li>
Company-paid Life Insurance</li><li>
Paid Holidays and Vacation</li><li>
Employee Referral Program</li><li>
Employee Assistance Program</li><li>
Wellness Programs</li><li>
Paid Community Service Opportunities</li><li>
Tuition Reimbursement</li><li>
Ongoing Training &amp; Personal Development</li><li>
And More!</li></ul>
About Safe-Guard Products International:
Safe-Guard serves Original Equipment Manufacturers (OEMs), top retailers, and independent agents in the automotive finance and insurance industry with the leading Protection Products Platform. Our platform delivers innovative protection products and solutions that protect consumers from the perils of ownership, while providing Finance &amp;Insurance professionals the tools to ignite scalable and sustainable business growth. Safe-Guard&rsquo;s success is driven by over 850 employees, who serve more than 12,000 dealers and support contract holders across the U.S. and Canada.
For 30 years and counting, our team continues to transform the motor vehicle space, earning a stellar reputation from our partners and peers by providing: 1) the highest quality protection products in the industry, 2) a broad platform of branded product, technology, marketing, and training solutions, and 3) an unwavering commitment to uncomplicated care and customer service.
Safe-Guard Products International is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to age, race, color, religion, creed, sex, sexual orientation, gender identity or expression, national origin, marital status, disability or protected veteran status, or any other status or characteristic protected by federal, state, or local law.</div>

Escalation Agent

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