GIG Gulf (a Fairfax company) is part of the Gulf Insurance Group (GIG), the #1 largest regional composite insurer in the Middle East and North Africa, with presence in 12 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 $ 4.01 billion and $84 million net profit for the year 2024.
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.
JobPurpose
To assess and evaluate the preapproval requests and processing medical claims in terms of medical eligibility, policy terms, attend calls and meet the client expectations appropriately by 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 (OP, IP, and Pharmacy [PBM] 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.
- To attend the call received from pharmacies for pre-approval of medications.
- Contribution in cost containment through GIG Guidelines and proper medical adjudication.
- Assist team in Customer care email management as required on adhoc basis.
- Involved in the processing of direct billing claims according to the department requirements. They may review complex claims, take decisions on claims settlements, resolve any issues or disputes that arise during the claims process. Ensure that claims are processed accurately, efficiently, and in compliance with company policies and insurance regulations.
- Communicate with the providers and other departments through emails and phone calls, which may include but are not limited to; claims registration, escalations, liaising with other departments, and handling provider queries.
- Adhereto and comply with all applicable laws, regulations, and industry standards. This may require conducting quality assurance audits, performing internal reviews, and reporting this to the line manager.
- 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…
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