Medical Insurance Supervisor

Medical Insurance Supervisor

Job Purpose

• Supervise and coordinate the day-to-day administration of the company's medical insurance program, ensuring the effective execution of all processes with the insurance provider and internal stakeholders, including contract administration, benefits implementation, approvals, and reimbursement claims.

Key Responsibilities

1-Health & Safety:

• Adhere to and enforce relevant legislation and policies and ensure that highest degree of safety and safe working
• practices are maintained.

• Ensure full compliance with Lafarge safety standards and promote safety culture and safe practices among the entire work
• force.
• Ensure all BP employees are operating in a safe working environment.
• Provide monthly reporting and statistics regarding safety performance and incidents.
• Ensure that all employees and contractors following Health Safety Rules.
• Conduct VPC and direct other key members in the company to do the same.
• Identify people with potential to assume broader safety responsibility.
• Submit the safety figures on monthly basis to the company and discuss areas of improvement.
• Lead investigations in major safety incidents.
• Review investigation reports on safety violation incidents and decide on additional actions to be taken.
• Assume key responsibility for developing H&S improvement plan and relevant action plans.
• Follow HSIP of the plant and follow the progress.
• Stopping Unsafe act.
• Ensure that all employees trained.
• Attending all safety Meeting
• Ensure that all employees follow SWI.
• Achieve Annual Health and safety personal objective.

2-Functional:

• Manage the day-to-day administration of the company's medical insurance program, including service delivery, claims processing, approvals, and provider network coordination.
• Administer employee medical insurance enrollment, additions, amendments, and terminations, ensuring accurate and timely coverage updates.

Medical Insurance Operations:

• Ensure the delivery of medical services in accordance with the approved Table of Benefits (TOB).
• Manage and monitor reimbursement claims, ensuring timely processing and resolution.
• Supervise prior authorization requests for medical services and treatments.
• Review and validate debit notes, side funds, and related financial transactions.
• Oversee daily case management activities and ensure proper follow-up on complex medical cases.
• Monitor the performance and effectiveness of the medical provider network, ensuring service quality and compliance with contractual agreements.
• Coordinate the enrollment of new employees and eligible dependents into the medical insurance scheme.
• Manage the timely removal of terminated employees and ineligible dependents from the medical insurance coverage.
• Prepare and analyze daily and monthly utilization and consumption reports to support cost control and decision-making.
• Review monthly invoices and supporting breakdowns to ensure billing accuracy.
• Supervise the performance of on-site GlobeMed physicians and administrative staff across all business units.
• Promote awareness of medical insurance benefits, coverage, and procedures through continuous employee communication and guidance.

Fit to Access Program:

• Supervise the daily Fit to Access medical examination process for contractors.
• Review medical documentation and ensure full compliance with established Standard Operating Procedure (SOPs) and company requirements.
• Coordinate with the Contractors Department to maintain updated approved medical provider lists and blacklisted records.
• Communicate medical assessment results to the relevant stakeholders in a timely and confidential manner.

Administration & Compliance:

• • Coordinate the submission and follow-up of employee sick leave documentation with the HR Shared Services (HRSS) team.
  • Create, monitor, and follow up on Purchase Requisitions (PRs) and Purchase Orders (POs) related to the Medical Department.
  • Receive, review, and maintain records of all Medical Department invoices.
  • Manage SAP transactions and requests, as well as other Holcim systems related to medical operations.
  • Prepare and maintain official correspondence with internal departments to support medical operations and employee services.
• Liaise with governmental authorities, including the Ministry of Health and the National Social Health Insurance Authority, ensuring compliance with all applicable regulations and requirements.

Education

Qualifications & Experience

Educational Background:

• Bachelor's degree in a relevant field.

Years of Experience:

• Minimum of 3 years of experience in the medical insurance field.

Technical Skills:

• Proficient in Microsoft Office applications (Excel, Word, PowerPoint, and Outlook).
• Hands-on experience using the iCare insurance system and other medical insurance management systems.
• Good understanding of medical insurance processes, including approvals, claims, reimbursements, and member administration.

Soft Skills:

• Strong leadership and supervisory skills with the ability to manage and guide a team.
• Excellent communication and interpersonal skills.