Insurance Manager

About the Role

Al Farabi Medical Group is seeking an experienced Insurance Manager to lead insurance operations across its dental clinics in Riyadh, Saudi Arabia. This full-time role involves managing relationships with insurance companies and third-party administrators (TPAs), ensuring efficient handling of approvals, claims, and settlements. The focus will be on maximizing claim acceptance, reducing rejections, improving collection cycles, and ensuring compliance with healthcare insurance regulations.

Key Responsibilities

• Manage and oversee insurance operations across all company branches.
• Build and maintain strong relationships with insurance companies, TPAs, and other relevant stakeholders.
• Supervise the full insurance claims cycle, including submission, follow-up, reconciliation, and settlement.
• Monitor pre-authorization requests and ensure timely processing of insurance approvals.
• Review rejected, denied, and pending claims, identify root causes, and implement corrective actions.
• Ensure accurate medical coding, documentation, and claim submission in accordance with payer requirements.
• Monitor insurance receivables, outstanding claims, collection rates, and payment delays.
• Analyze insurance performance reports and develop action plans to improve claim acceptance and revenue collection.
• Coordinate with clinic managers, dental teams, reception, and billing departments to resolve insurance-related issues.
• Ensure compliance with applicable health insurance regulations, payer policies, and internal procedures.
• Develop and implement insurance policies, workflows, and standard operating procedures across branches.
• Train and supervise the insurance team, set performance targets, and monitor key performance indicators (KPIs).
• Review insurance contracts, fee schedules, and reimbursement terms, and support negotiations with insurance providers.
• Prepare periodic reports for senior management covering claim performance, rejections, collections, and operational challenges.

Key Performance Indicators

• Insurance claim acceptance rate.
• Claim rejection and denial rate.
• Average claim processing and collection time.
• Outstanding insurance receivables.
• Insurance collection rate.
• Pre-authorization turnaround time.
• Insurance revenue and reimbursement accuracy.

Experience and Qualifications

Candidates should possess 5-10 years of relevant experience in insurance management, preferably within the healthcare sector. A strong understanding of healthcare insurance regulations, claims processing, and relationship management with insurance providers is essential for this role.

Work Environment

This is a full-time position based in Riyadh, Saudi Arabia, within a dynamic medical group focused on dentistry and orthodontics. The role requires collaboration with various internal departments and external stakeholders to optimize insurance operations.