Sr. Officer – Claims Monitoring - TPA

الوصف الوظيفي
Role Purpose:

To establish a full control on TPA’s providers’ financial reconciliation and payments; playing a gate keeper role to ensure accuracy and avoid over / under payments to be made within agreed KPIs with stakeholders

Accountabilities:

Medical Providers Control (TPA)

Prepare the provider’s financial reconciliation and perform a role of gatekeeper of payments and ensure to apply the accurate payments
Reconcile the Providers accounts from different systems including Accpac, Caesar and our internal documents to make sure all figures are accurately recorded and track historical record of the providers’ monthly payments
Monitor & ensure accuracy of provider payments documentation flow requests sent by claims; and ensure all required supporting documents are in place prior to payments
Manage the recovery of over payments from providers to keep the payments log accurately
Provider’s Settlement (TPA)

Generate the Commercial Financial Figures for Provider relations team as a baseline for decision making
Ensure that prompt payment discounts and volume discounts are applied correctly
Manage all of the negative Full & Final settlement and supervise the process of collecting the negative provider settlements amounts in order to secure accurate settlements for our accounts
Resolve and reconcile provider’s yearly opening balances by Mid-year and coordinate with the Provider relations and claims department in order to settle the provider’s accounts in an efficient way
Provider Analysis

Prepare the weekly NBS by monitoring the variance between projected and actual costs through the batches received versus projections and make enhancements as required
Fully understand the TPA models to be a backup for the manager while also providing insight on the cost trends and analysis
Regulatory & External Audit

Assist in ensuring that the reporting system and provider payments are well supported by documents and policies & procedures to support the TPA audit
المهارات
Years of Experience

0-2 years of experience
Skills Required (Technical)

Strong MS office skills.
Analytical and reporting skills with a good understanding of the business drivers.
Other Requirements

BSC Degree in Finance, Accounting
Strong commuincation skills
Process and results orianted, with strong attention to details
تفاصيل الوظيفة
منطقة الوظيفة جدة, المملكة العربية السعودية
قطاع الشركة خدمات الدعم التجاري الأخرى
طبيعة عمل الشركة صاحب عمل (القطاع الخاص)
الدور الوظيفي المحاسبة والتدقيق
نوع التوظيف --
الراتب الشهري غير محدد
عدد الوظائف الشاغرة غير محدد
المرشح المفضل
المستوى المهني مبتدئ الخبرة
عدد سنوات الخبرة الحد الأدنى: 0 الحد الأقصى: 2

*** تقدم على الرابط التالي : Apply on the following link ***
https://www.bayt.com/ar/saudi-arabia/jobs/sr-officer-claims-monitoring-tpa-4138993/