Plan Sponsor LiaisonPrimary Location: United Arab Emirates
Additional Locations: ARE-Dubai Apply
To oversee the MOFA (KSA/MAEC/Kuwait) claims process, ensuring member satisfaction through personal expertise and coordination with other departments as required to deliver a fully integrated service proposition and effective operational controls.
To serve as the Subject Matter Expert for members, MOFAs, TPAs/Partners (Tawuniya/Wapmed/Atlanta), and our internal teams globally, and ensure efficient and effective administration of the plan, managing and resolving escalated and complex global issues for Claims/Calls and PSS.
Fundamental Components & Physical Requirements:
- Attend/ participate in internal and external meetings relating to the MOFAs
- Acts as a single-point-of-contact for escalated member-specific issues and/or broader plan administration matters
- Deliver support to internal teams – MST (Manila and Dubai),HGS India, and MAT/IHAT, CRT and Network teams globally
- Proactively identify and surface customer and plan issues for resolution while acting as a liaison to communicate workflow results, ideas and solutions.
- Proactively resolve issues with account executives, sales representatives, installation managers and the claims office as appropriate.
- Responding to official communications (Letters/Emails from Ministry) with thorough action plan.
- Manage escalated customer issues
- Provide quality assurance checks on the MST Dubai team call handling, providing feedback and coaching where appropriate to improve delivery to the customer
- Lead on planning and execution of quality calibration meetings with Partners at plan renewal to ensure all parties have consistency in the interpretation of the TOB/plan and in the assessment of claims.
- Monthly/Quarterly reports on key performance areas (Claims/Networks/Complaints) of the plan and ad hoc requests coming from Account Managers
- Proactively analyzes constituent data, identifies trends and issues and recommending remedial actions
- Identifies most urgent business problems, obtains necessary information, accurately identifies root causes and generates solutions.
- Initiates and maintains partnerships with others throughout the organization. Encourages cooperation by promoting common goals and building trust. Inspires, supports, and initiates cross-functional activities.
- Experience with claim/call center environment (Must)
- Strong customer service delivery background (Must)
- Extensive experience working with MS Excel
- Medical background (Must)
- Arabic Language Capabilities: Arabic & French (Required) and English (in order to cater to all three MOFAs) (Must)
- Account Management experience and/or Plan Sponsor Service experience
- Medical education degree
- Demonstrates strong consultative skills and the ability to influence constituents
- Strong leadership skills
- Strong communication skills (verbal, written, presentation)
- Strong understanding of multiple aspects of the plans and products (e.g., CCI coding)
- Ability to work with cross-functional business units and vendors to support the customer’s needs; promotes collaboration among constituents and represents a professional image of the company.
- Strong project management skills
- Ability to support multiple plan sponsors and multiple products
- Critical thinking and decision making skills
- Automatic adjudication knowledge (e.g., number of claims affected on on-standard plans, knowing when a benefit auto adjudicates)
- Strong knowledge of Aetna Standards
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