Location: UAE
Key Responsibilities:
– Conduct audits of healthcare providers’ claims to ensure accuracy and compliance.
– Review claims for medical necessity, correct coding, and adherence to insurance and regulatory standards.
– Analyze data to identify trends such as overutilization, overbilling, or policy non-compliance.
– Collaborate with the claims department and other internal teams to support the implementation of corrective actions.
– Maintain detailed audit documentation and generate reports for both management review and regulatory submissions.
– Stay current with UAE healthcare regulations, including DHA, DOH, MOH guidelines, and payer-specific policies.
Desired Candidate’s Profile:
– 3-5 years of experience in medical claims auditing within the UAE healthcare/insurance sector.
– MBBS/BDS is mandatory. Additional qualifications or certifications such as CPC/CPMA are an added advantage.
– Familiarity with UAE health authority guidelines (DHA, DOH, MOH).
– Strong claims auditing and claims adjudication skills.
– Excellent communication skills
– Ability to work independently and as part of a team