Senior Executive Director - Health Operations
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Salary Not Disclosed
1 Vacancy
Job Description
General Overview:
Our client a prominent leader in the Insurance industry is looking to hire a Senior Executive Director Health Operations to join their team in Riyadh KSA. The successful candidate will be responsible for directing and overseeing the organizations operational improvements and automation initiatives.
Key Responsibilities:
- Lead the establishment and of the Departments annual plan budget objectives and initiatives in line with the companys strategic objectives and set KPIs.
- Direct the departments operations and activities within budget and devise strategies that result in a positive financial impact.
- Oversee provider network and build longlasting relationships with providers to deliver costeffective and efficient services to customers.
- Facilitate and manage the audit and reconciliation process ensuring the use of clear supporting documents for claim costs and prompt detection and assessment of fraudulent activities.
- Intervene in critical negotiations with providers to agree on price lists and establish processes (i.e. billing claims etc. and oversee provider contracts ensuring adherence to the Business needs.
- Oversee capability building and saving programs and provide input to maximize effectiveness in reducing costs and increasing profitability.
- Ensure claims management processes (i.e. preauthorization reimbursement etc. and medical treatment assessments are in line with preset guidelines procedures and regulations.
- Ensure the adjudication of claims are accurate based on the medical and technical claims assessment.
- Oversee fraud management system controls and coordinate with Planning and Quality to validate their compliance and effectiveness.
- Oversee processing and justification of Health claims ensuring adherence to relevant guidelines and regulations set by CCHI MoH etc.
- Leverage medical data analyses and KPI results to direct action plans to bridge gaps and drive operational excellence.
- Keep abreast of latest updates in the delegation of authority (DoA) to ensure all operations handled by Policy Administration function are compliant with the preset mandate and scope of work.
- Facilitate coordination with Underwriting to ensure timely escalation of policy administration requests when repricing/risk reassessment are needed.
- Refine the organizations strategy in alignment Ministry of Hajj and Umrah.
- Guide relationships and facilitate interactions as needed with external stakeholders such as thirdparty administrators (TPA) Ministry of Health Ministry of Finance CCHI SAMA Ministry of Hajj and Umrah brokers etc. to ease collaboration.
- Oversee Hajj and Umrah activities related to portfolio management claims review/approval etc. ensuring alignment with relevant guidelines risk levels and financial capability.
- Ensure continuous performance improvement of operations based on latest gaps and objectives.
- Direct the development of the Departments policies processes and procedures to increase productivity attain high quality outputs and cost effective results in line with relevant regulatory requirements.
- Lead the development enhancement and implementation of control systems and the resolution of escalated noncompliance cases.
- Direct the departments talent acquisition development and management activities.
- Lead setting team members objectives clarifying expectations reviewing performance periodically providing regular feedback coaching and confronting unsatisfactory behavior or performance.
- Promote a highperformance and an accountable working environment.
Requirements
- A Bachelors Degree in Medicine Accounting Finance or equivalent is required.
- A Masters Degree in Business Administration Accounting Finance or equivalent is preferred.
- Minimum 13 years of experience in the field of health insurance with at least 6 years of experience in a managerial position.
Required Experience:
Director
Employment Type
Full-Time
