Skip to main content

A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Plan Sponsor Liaison

Primary Location: United Arab Emirates
Additional Locations: ARE-Dubai
Apply
Description:
Family Summary/Mission:
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.


Position Summary/Mission:
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.


Background/Experience Desired:
  • 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

Educational Requirements:
  • Medical education degree

Additional Information
  • 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


Click To Review Our Benefits (PDF)

Apply

Jobs for you

Recently Viewed Jobs

You do not have any recently viewed jobs

Your Saved Jobs

You do not have any saved jobs

Sign up for Job Alerts

Join our Talent Community

At Aetna, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna.

Join Our Talent Community

Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna.