Insurance Manager

Job Summary Al Farabi for Dentistry and Orthodontics is seeking an experienced Insurance Manager to oversee insurance operations across its dental clinics, manage relationships with insurance companies and third-party administrators (TPAs), and ensure efficient handling of insurance approvals, claims, and settlements. The successful candidate will focus on maximizing claim acceptance, reducing rejections, improving collection cycles, and ensuring compliance with applicable healthcare insurance regulations. Key Responsibilities • Manage and oversee insurance operations across all company branches. • Build and maintain strong relationships with insurance companies, TPAs, and other relevant stakeholders. • Supervise the full insurance claims cycle, including submission, follow-up, reconciliation, and settlement. • Monitor pre-authorization requests and ensure timely processing of insurance approvals. • Review rejected, denied, and pending claims, identify root causes, and implement corrective actions. • Ensure accurate medical coding, documentation, and claim submission in accordance with payer requirements. • Monitor insurance receivables, outstanding claims, collection rates, and payment delays. • Analyze insurance performance reports and develop action plans to improve claim acceptance and revenue collection. • Coordinate with clinic managers, dental teams, reception, and billing departments to resolve insurance-related issues. • Ensure compliance with applicable health insurance regulations, payer policies, and internal procedures. • Develop and implement insurance policies, workflows, and standard operating procedures across branches. • Train and supervise the insurance team, set performance targets, and monitor key performance indicators (KPIs). • Review insurance contracts, fee schedules, and reimbursement terms, and support negotiations with insurance providers. • Prepare periodic reports for senior management covering claim performance, rejections, collections, and operational challenges. Qualifications • Bachelor's degree in Business Administration, Finance, Healthcare Administration, or a related field. • 5+ years of experience in medical insurance operations, preferably within dental clinics, hospitals, or multi-branch healthcare organizations. • Previous experience managing insurance operations across multiple branches is highly preferred. • Strong knowledge of Saudi health insurance regulations and the requirements of the Council of Health Insurance (CHI). • Proven experience in insurance claims management, pre-authorizations, claim rejections, resubmissions, and reconciliation. • Good understanding of dental procedures, medical coding, and insurance billing requirements. • Experience dealing with insurance companies and third-party administrators (TPAs). • Strong analytical skills and proficiency in Microsoft Excel, reporting tools, and healthcare insurance systems. • Excellent leadership, communication, negotiation, and problem-solving skills. • Ability to manage multiple priorities and improve operational performance across branches. Key Performance Indicators (KPIs) • Insurance claim acceptance rate. • Claim rejection and denial rate. • Average claim processing and collection time. • Outstanding insurance receivables. • Insurance collection rate. • Pre-authorization turnaround time. • Insurance revenue and reimbursement accuracy.

Manage and oversee insurance operations across all company branches. Build and maintain strong relationships with insurance companies, TPAs, and other relevant stakeholders. Supervise the full insurance claims cycle, including submission, follow-up, reconciliation, and settlement. Monitor pre-authorization requests and ensure timely processing of insurance approvals. Review rejected, denied, and pending claims, identify root causes, and implement corrective actions. Ensure accurate medical coding, documentation, and claim submission in accordance with payer requirements. Monitor insurance receivables, outstanding claims, collection rates, and payment delays. Analyze insurance performance reports and develop action plans to improve claim acceptance and revenue collection. Coordinate with clinic managers, dental teams, reception, and billing departments to resolve insurance-related issues. Ensure compliance with applicable health insurance regulations, payer policies, and internal procedures. Develop and implement insurance policies, workflows, and standard operating procedures across branches. Train and supervise the insurance team, set performance targets, and monitor key performance indicators (KPIs). Review insurance contracts, fee schedules, and reimbursement terms, and support negotiations with insurance providers. Prepare periodic reports for senior management covering claim performance, rejections, collections, and operational challenges.