Specialist, Medical Insurance Administration

Role Overview

Specialist, Medical Insurance Administration at Ma'aden. This role manages and administers employee medical insurance services, work injury processes, and healthcare coordination activities while ensuring compliance with regulatory requirements and company policies.

Role Purpose

Support employees' medical needs through effective insurance administration, claims management, healthcare provider coordination, and occupational health compliance.

Key Responsibilities

Insurance Administration

• Administer employee medical insurance programs in compliance with Health Insurance Council (CHI) regulations.
• Coordinate insurance approvals, coverage inquiries, escalations, and monitoring of medical coverage limits.
• Maintain accurate medical insurance and employee healthcare records.

Claims & Compliance Management

• Review, validate, and process employee medical expense claims in accordance with company policies.
• Manage GOSI registration, reporting, and follow-up for all work-related injury cases.

Employee & Healthcare Support

• Support employees with medical insurance inquiries and healthcare service requirements.
• Coordinate pre-employment medical examinations for new hires.
• Coordinate medical travel arrangements for employees requiring specialized treatment within and outside the Kingdom.

Healthcare Provider Management

• Ensure quality and effectiveness of healthcare providers, including company clinics and external medical facilities.
• Conduct site visits to hospitals and medical facilities to monitor service quality and compliance with approved healthcare standards.

Qualifications & Experience

Education

• Bachelor's degree in healthcare administration, Business Administration, Human Resources, or a related field.

Experience

• Minimum 2 years of experience in medical insurance administration, healthcare services, employee medical support, or a related healthcare field.

Skills & Competencies

• Knowledge of Health Insurance Council (CHI) Regulations
• GOSI Platform Management
• Patient Service Experience and Employee Medical Support
• Knowledge of Medical Terminology
• Medical Insurance Coordination and Provider Management
• Hospital and Healthcare Industry Experience
• Microsoft Office (Excel, Word, PowerPoint, Outlook)
• Strong Communication and Stakeholder Management Skills
• Analytical Thinking and Problem Solving
• Time Management, Planning, and Organization
• English Language Proficiency
• Teamwork
• Integrity
• Care
• Ownership
• Communication
• Accountability
• Customer Focus
• Service Excellence