Medical Claims Manager

About the role

MedNet Bahrain is looking for a Manager - Medical & Claims to lead its medical and claims operations, covering authorizations, claims management and medical governance. The manager ensures high-quality, efficient and customer-centric services, works with healthcare providers, insurers, clients and internal stakeholders, and manages medical costs while improving the customer experience.

Key responsibilities

• Lead and manage the Medical Authorizations and Claims teams, keeping them performing well and meeting operational KPIs.
• Oversee review and approval of medical authorizations in line with clinical guidelines, policy terms and best medical practices.
• Manage end-to-end claims operations so assessments and settlements are accurate, timely and consistent.
• Drive medical cost containment through utilization management and evidence-based decisions.
• Monitor service delivery standards and compliance with service level agreements and quality metrics.
• Build relationships with clients, insurers, healthcare providers and other stakeholders.
• Run continuous improvement initiatives to boost efficiency, customer service and process effectiveness.
• Mentor and develop team members and support operational policies, procedures and governance.
• Ensure compliance with regulatory requirements, internal controls and company standards.
• Collaborate with cross-functional teams on strategic projects and analyse performance data to support decisions.

Required profile

• Medical degree from a university recognized by the WHO.
• At least 6 years of clinical practice, including at least 3 years in a TPA, health insurance or managed healthcare setting.
• Previous leadership experience managing operational or medical teams.
• Strong understanding of health insurance operations, medical authorizations, claims adjudication and healthcare regulations.
• Ability to work in a fast-paced, multicultural environment.