Specialist Medical Insurance Administration III📣 Job Ad

About the Role

Maaden is seeking a Specialist Medical Insurance Administration III to join its team in Riyadh, Saudi Arabia. This full-time role is central to managing and administering employee medical insurance services, overseeing work injury processes, and coordinating healthcare activities. The Specialist ensures strict compliance with regulatory requirements and company policies, providing essential support for employees' medical needs.

Role Purpose and Scope

The primary purpose of this position is to ensure effective medical insurance administration, efficient claims management, and seamless coordination with healthcare providers. The role is critical in maintaining occupational health compliance and supporting employees through various medical inquiries and service requirements, contributing to overall employee well-being.

Key Responsibilities

• Administer employee medical insurance programs in compliance with Health Insurance Council (CHI) regulations.
• Coordinate insurance approvals, coverage inquiries, escalations, and monitor medical coverage limits.
• Review, validate, and process employee medical expense claims in accordance with company policies.
• Manage GOSI registration, reporting, and follow-up for all work-related injury cases.
• Coordinate pre-employment medical examinations for new hires.
• Maintain accurate medical insurance and employee healthcare records.
• Support employees with medical insurance inquiries and healthcare service requirements.
• Ensure the quality and effectiveness of healthcare providers, including company clinics and external medical facilities.
• Conduct site visits to hospitals and medical facilities to monitor service quality and compliance with approved healthcare standards.
• Coordinate medical travel arrangements for employees requiring specialized treatment within and outside the Kingdom.

Qualifications and Experience

Candidates for the Specialist Medical Insurance Administration III role should possess 5-10 years of relevant experience in medical insurance administration, claims management, or a related healthcare coordination field.

Compliance and Quality Assurance

A fundamental aspect of this position involves ensuring strict adherence to Health Insurance Council (CHI) regulations and company policies across all medical insurance administration activities. The Specialist is also responsible for monitoring and ensuring the quality of services provided by both internal company clinics and external medical facilities, upholding approved healthcare standards.

Work Environment

This is a full-time position based in Riyadh, Saudi Arabia. The role requires active engagement in managing employee healthcare services and coordinating effectively with various internal and external stakeholders to ensure comprehensive support.