Specialist, Medical Insurance Administration III

Job Purpose
Manage and administer employee medical insurance services, work injury processes, and healthcare coordination activities while ensuring compliance with regulatory requirements and company policies. The role supports employees’ medical needs through effective insurance administration, claims management, healthcare provider coordination, and occupational health compliance.

Key Accountabilities

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

Minimum Qualifications

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

Minimum Experience

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

Skills

• 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

Competencies

• Teamwork
• Integrity
• Care
• Ownership
• Communication
• Accountability
• Customer Focus
• Analytical Thinking
• Problem Solving
• Planning and Organizing
• Service Excellence