Medical Call Centre Executive – Omani

Medical Call Centre Executive – **Omani nationals ONLY**

Who we are

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 Algeria, Bahrain, Egypt, Iraq, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Turkey and the United Arab Emirates. GIG Group reported consolidated assets stand at US$ 4.4 billion as of 31 December 2022. The majority shareholder of GIG Group is Toronto based Fairfax Financia 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 assess and evaluate the preapproval requests and calls in terms of medical eligibility, policy terms and meeting the client expectations appropriately and providing a World Class Customer Service experience throughout the process. To respond to and liaise as required with GIG policy holders, insurance brokers and network providers in a professional and courteous manner.

Key Responsibilities:

• Adjudicating and Processing insurance pre-approvals in a timely and accurate manner following Company policy terms and conditions, process Guidelines. Process Pre-approvals within the agreed TAT per line of business.
• To attend the calls received from members, brokers, providers, clients within SLA.
• Contribution in cost containment through GIG Guidelines and proper medical adjudication.
• Assist team in Customer care email management as required on adhoc basis.

Operational & technical responsibilities:

• Sound knowledge of medical and insurance guidelines
• Ability to understand the different aspects of the Healthcare Platform to be able to direct queries to the relevant parties where necessary.
• Sound knowledge of local regulations in Oman.
• Decide on pre-approval based on medical necessity and internationally accepted medical guidelines.
• Reporting of provider abuse if it is found to be recurrent as part of the cost-containment strategy of the health care operation.
• Respond to calls from providers, members, brokers, clients in a professional and courteous manner to deliver a World Class Customer Service experience throughout the process.
• To keep all files & information confidential.
• Provide extraordinary service to our customers via phone, email, and other access channels
• Taking end to end ownership for the resolution of all customer enquiries and contacts. Manage all queries through to resolution
• Accurately maintaining and updating customer records on the customer management system. Ensure that records are accurately updated whenever a customer makes contact
• Achieving all targets for contact handling, turnaround times, quality, productivity, and many others as established by the management
• Receiving and responding to telephone and written inquiries relating to healthcare policy benefits and claims from either private or corporate clients/policyholders.

Role Requirements:

Essential:

• Omani National (due to regulatory requirement, this role is open ONLY for Omani nationals)
• 1- 2 years’ experience in Medical Insurance Process.
• 6 months to 1 Year experience in handling calls
• Medical Degree (Medical / Dental/ Nursing /Pharmacy/Physiotherapy)
• Regional experience and working knowledge of healthcare regulations in Oman.
• Medical Knowledge, Medical Terminology, and Computer handling skills
• Strong communication (verbal & written)

Desirable:

• Good analytical skills
• Customer-focused
• Ability to work effectively within a team environment.
• Highly motivated and proactive
• Results-driven and solution-oriented