Description
You will protect and restore the member experience by supporting dissatisfied members, resolving complex and sensitive concerns, and ensuring each case has clear ownership through to resolution.
You will also serve as Cigna Healthcare KSA's focal point for the TCS hospital delegate team and provide dedicated support to VIP members and key corporate accounts. The position is based in Riyadh, Saudi Arabia, with hospital visits required when needed. Working hours are Sunday to Thursday on a full-time basis.
Responsibilities:
- Review negative CSAT and NPS feedback, acknowledge cases within four working hours, and make the first contact attempt within 24 working hours.
- Coordinate with relevant teams to resolve member concerns, provide updates throughout the process, and close cases within 48 working hours while documenting outcomes and root causes.
- Register new complaints on the same working day in line with the Complaints Management Policy and manage VIP or high-priority complaints within Insurance Authority timelines.
- Own complex, sensitive, and repeat cases, including callbacks relating to rejected or pending claims and approval updates.
- Act as the main contact for the TCS hospital delegate team, coordinating escalations, urgent hospital cases, and pending requests through approved and secure channels.
- Provide dedicated support to VIP members and key corporate accounts, maintain relationships with hospital delegates and patient relations departments, and follow up on delayed approvals with the Medical Approvals team.
- Maintain accurate CRM and survey records, identify recurring issues, share relevant feedback trends, and escalate sensitive, regulatory, or reputational risks without delay.
Success measures include:
- At least 95% of cases acknowledged within four working hours.
- At least 98% of first contact attempts made within 24 working hours.
- At least 95% of cases closed within 48 working hours.
- 100% of new complaints registered on the same working day.
- 100% of members updated on open escalated cases.
- At least 50% of cases resolved or showing improved member sentiment.
Requirements:
- A bachelor's degree in healthcare administration, business administration, health insurance, or a related field.
- At least five years of experience in health insurance, healthcare services, hospital operations, or customer service.
- Sound knowledge of the Saudi health insurance environment and CHI and IA regulatory requirements.
- Fluency in written and spoken Arabic and English.
- The ability to handle confidential member information with discretion and integrity.
Soft Skills:
- Clear, respectful communication and effective member handling.
- Empathy when supporting members with sensitive concerns.
- Ownership and consistent follow-through.
- Practical problem-solving and stakeholder coordination.
- Ability to manage deadlines and time-sensitive cases.
Technical / Functional Skills:
- Complaint handling, escalation management, and service recovery.
- Customer satisfaction measures, including CSAT and NPS.
- Microsoft Office and customer service systems.
- Accurate CRM and customer survey system recordkeeping.
- Coordination across Customer Service, Complaints, Customer Experience, Claims, Medical Approvals, Medical Operations, Provider Relations, Finance, Digital, and Compliance.
Benefits:
- Competitive salary.
- Multicultural and hybrid working environment.
- Private Medical Insurance.
- Employee Wellbeing Benefits.
- Educational Development Program.