Medical Reimbursement Claims Executive

Who Are We:

GIG Gulf is part of the Gulf Insurance Group (GIG), the #1 largest regional composite insurer in the Middle East and North Africa, with presence in 13 markets including the United Arab Emirates, Bahrain, Oman, Qatar, Saudi Arabia, Algeria, Egypt, Iraq, Jordan, Kuwait, Lebanon, and Turkey. GIG Group reported consolidated assets of US$ 3.83 billion and $69 million net profit for the year 2023. The majority shareholder of GIG Group is Toronto based Fairfax Financial Holding, a global leader in insurance and reinsurance with a presence in 40 markets.

GIG Gulf is an ‘A’ rated regional insurer with a top 5 position in each of its markets (UAE, Oman, Qatar, Bahrain). GIG Gulf has been present in the region for over 70 years with a strategic focus on both growth and investments and is a one stop shop offering a wide range of insurance products and services that cater to a broad variety of needs for corporates, SMEs and individual customers throughout UAE, Oman, Bahrain, and Qatar. GIG Gulf also owns a 50% stake in GIG Saudi. Our strategic objectives and guiding principles are focused on Regional Growth, Customer Experience and Digital Transformation.

GIG Gulf has created a diverse and inclusive working environment and culture with a workforce of over 800 employees, with over 60 nationalities, across 15 branches and retail shops region-wide and over 1 million customers. GIG Gulf is a caring partner that encourages customers to achieve their goals and live an inspiring and fulfilling life. We are obsessed with customer feedback and continuously evolving to become the region’s digital insurer of reference, committed to running our operations in a responsible, sustainable way.

Job Purpose:

To process insurance claims in a timely and accurate manner in accordance with Claim’s policy. To respond to and liaise as required with GIG policy holders, insurance brokers and network providers in a professional and courteous manner.

Key Responsibilities:

1. To process claims following defined procedures and in accordance with the conditions & terms of the policies.
2. To handle relationships with Members by asking for additional information whenever required, by explaining the details of the settlements (application of the deductible and coverage, justify rejections and uncovered expenses…)
3. To process the claims within a reasonable time frame within SLA.
4. To minimize conflicts with members whilst applying strictly the policy terms and conditions.
5. To reject claims lately declared by clients as per Policy Wording.
6. To approve claims within the authority limits set and to refer cases to the Manager for approval where authority limits are exceeded.
7. To process claims as per claims guidelines.
8. To keep all files & information confidential.

Operational & Technical Responsibilities:

1. The job requires a basic understanding of related areas such as accounts/billing.
2. The job holder requires a broad knowledge of GIG Insurance policies.
3. The job requires a general understanding of the Branch structure and policy setups.
4. Basic knowledge of insurance industry.
5. Basic medical terminology and computer handling skills.

Essential Requirements:

1. The role requires little independent thought or judgment acting within well-defined policies and procedures.
2. Problems are routine/basic in their nature. More complex issues are referred to more senior staff for resolution.
3. The job works under close supervision and operates within defined Claims policies and operating procedures.
4. Nonstandard issues and requests / requirements beyond established authority levels are referred to next level management for resolution or direction.