Head of Department ( Medical and Life Insurance Claims )📣 إعلان

About the Role

Global Recruitz is seeking a Head of Department (Medical and Life Insurance Claims) to lead the medical insurance underwriting, operations, and claims functions for a reputed insurance company. This full-time position is based in Riyadh, Saudi Arabia, and is critical for developing strategies that balance risk, customer satisfaction, and compliance within a dynamic insurance market. The role involves ensuring a robust risk management framework that aligns with organizational goals and profitability targets.

Core Responsibilities

• Lead medical insurance underwriting and claims strategies, ensuring alignment with company goals and regulatory requirements.
• Oversee the complete lifecycle of underwriting and claims processing for medical insurance products.
• Manage high-value and complex life and medical claims escalations.
• Address complex medical insurance issues, including cross-border claims and advanced treatments.
• Coordinate with internal stakeholders to integrate claims and underwriting processes effectively.

Strategic Leadership and Innovation

• Drive innovation through the utilization of AI and machine learning to enhance underwriting accuracy and claims processing efficiency.
• Collaborate with senior leadership to integrate medical underwriting into the broader business strategy.
• Develop and implement medical underwriting guidelines that balance risk and profitability.
• Lead risk assessment for the underwriting of both individual and group policies.
• Utilize predictive analytics to improve risk assessment and decision-making processes.
• Implement fraud detection systems and claims automation technologies.
• Build and maintain relationships with healthcare providers, reinsurers, and brokers.

Financial Oversight and Compliance

• Accountable for the financial performance of medical underwriting and claims, including loss ratio management and cost containment.
• Ensure compliance with all regulatory requirements for underwriting and claims processing.
• Work with compliance teams to align processes with solvency and Anti-Money Laundering (AML) rules.
• Operate within a regulated insurance environment, adhering to relevant laws and data protection standards.

Key Performance Indicators

• Proper underwriting practices and underwriting profitability ratio.
• Efficiency of medical claims settlement.
• Customer relationship management, satisfaction, and retention.
• Regulatory and compliance performance for both medical and life insurance lines.

Required Experience

Candidates should possess 5-10 years of relevant experience in medical and life insurance claims and underwriting leadership roles. A proven track record in managing complex insurance operations and driving strategic initiatives is essential for this position.