Job Purpose:

To be responsible for performing providers Audit Campaign, and identifying unfavorable trends in providers billing, maximize audit findings and recovery through providing solid audit ground.

Responsibilities:

• Assists the Line Manager in implementing and managing claims denial, approvals communication and management with TPA, health care provider, insured member and health care regulators (Dubai Health Authority/ Health Authority of Abu Dhabi). Conducts medical audit for fraud, waste or abuse with health care providers.
• Assists in the review of claims which are suspected for abuse and medical claims audit with TPA.
• Responds for home country members approval and claim coordination with TPA.
• Implements knowledge of HAAD/ DHA regulations without TPA on claims management.
• Performs audit of TPA performance.

Minimum Requirements:

• Completed MBBS / MBChB/ Equivalent Degree.
• Proficient knowledge of HAAD & DHA.
• Working knowledge of general practices for medical insurance procedures.
• At least 1 – 3 years’ experience in a similar role in Healthcare Audit with coding experience in the UAE Insurance Industry.
• Freshers with MBBS / MBChB/ Equivalent Degree may also apply.
• Good communication skills in Arabic both written & oral.
• Candidates having work experience as Medical Doctors in Government Hospitals in the UAE (Preferable).
• Coding certification; CPC & IPDRG (Preferable).

Job Code: DA0321

Role: 

The successful candidate will turn data into information, information into insight and insight into business decisions.

Responsibilities:

Data Analysts often make recommendations about the methods and ways in which a company obtains and analyzes data to improve quality and the efficiency of data systems, but not be limited to:

• Collecting and interpreting data.
• Analyzing results.
• Reporting the results back to the relevant members of the business.
• Identifying patterns and trends in data sets.
• Working alongside teams within the business or the management team to establish business needs.
• Defining new data collection and analysis processes.
• Data Analyst job qualifications and requirements.

Education:

A degree in the following subjects is beneficial: Mathematics, Computer Science, Statistics, Economics.

Skills & Experience:

• Experience in data models and reporting packages.
• Ability to analyze large datasets.
• Ability to write comprehensive reports.
• Strong verbal and written communication skills.
• An analytical mind and inclination for problem-solving.
• Attention to details.
• Freshers with similar skills may also apply.
• Insurance Industry background preferable.

Job Responsibilities:

• Responsible for innovation and end-to-end launch of products.
• Collaborates with Operations team & Broker channel partners and individual customers to co-develop a roadmap and drive products and features from concept to launch in a fast-paced environment.
• Works with cross-functional teams and various stakeholders, including analytics, design/user experience, re-engineering processes, and user enablement.
• Turns data insights into products with actionable outcomes to the ultimate customer.
• Works in an Agile environment and continuously reviews the business needs, refine priorities, outlines milestones and deliverables, and identifies opportunities and risks.
• Broker channel Partners with stakeholders and customers across the organization to inform the product vision, strategy, features, and prioritization.
• Develops, owns, and executes product roadmap.
• Works with user-focused departments to define the self-service user experience, support, and monitoring for customers.
• Partners with sales departments & Brokers to define the Digital customer experience, including IT / Operations / Customer service support and monitoring.
• Translates product roadmap features into well-defined product requirements including features, user stories, and acceptance test criteria.
• Prioritizes and maintains the sprint of renewals for assigned products, balancing the requirements of stakeholders.
• Leads the product functional design process based on an intimate knowledge of the users and technology with the Product development, IT , Operations & Marketing team.
• Defines and executes the go-to-market plan, working to ensure that product management, Digital marketing, and B2C sales have what they need to be successful.
• Develops and maintains appropriate tracking and reporting of product performance post-launch to evaluate a future investment. 

Qualifications & Skills:

• Balance of Digital Marketing knowledge and business acumen.
• Customer first, Outside the Box  thinking mind set.
• Proactive, self-starter with excellent project management skills and ability to manage multiple tasks effectively.
• Excellent communication skills with the ability to engage, influence, and inspire partners and stakeholders to drive collaboration and alignment.
• High degree of organization, individual initiative, and personal accountability.

Education & Experience Requirements:

• Bachelor’s degree and 5 years of product or Market development experience (Individual Medical Insurance, Bancassurance, Financial Services, Luxury Products).
• At least 1 year of experience in Product Management and/or Product Development / or Market Development.
• Proven track record of delivering data driven solutions with a customer-first mindset.
• Digital Marketing & Sales background.
• Preferably from Individual Medical Insurance, Bancassurance, Financial Services, Luxury Products.
• Fintech / Finserv/ Insurtech background.

Requirements:

• The ideal candidate should have a Bachelor’s degree in healthcare and should have relevant experience in UAE.
• A minimum of 2 years’ experience in claims processing and audit is a must.
• Should have a reasonable knowledge of claims data analytics and advanced MS Office expertise.
• Strong verbal and written communication skills, including an ability to effectively lead interactions with both business and technical teams.

Roles & Responsibilities:

• Coordinating with TPAs to ensure the outstanding amounts that have been projected are in line with the utilization reports.
• Secure a payment plan from the TPA to settle the outstanding amounts to providers
• Verification with the providers regarding the receipt of payment from TPAs as confirmed.
• Coordinate with TPA and Provider to conclude and close on the claims under reconciliation.
• Maintain records to ensure there is no undue delay in settlement of claims to the provider in line with the DHA/HAAD recommendation.
• Conducting commercial audit on the claims and maintaining the data of the audits with possible outcome.
• Prepare and analyze reports of audit review and performance issues with a focus on identifying trends.
• Escalating the findings to the relevant team member and document the actions taken.
• Create, measure, and analyze various KPIs to inform decisions and support recommendations.

Job Code: OPOS1121

Role and Responsibilities

1. Assists POS personnel in the operation
2. Controls expenses of the department in areas such as equipment needed, forms, stationery, telephone, fax charges, etc.
3. Ensures that company standards are met and kept up to date
4. Ensures that POS comments are properly documented by self and all POS personnel in chronological and concise manner
5. Ensures that daily and monthly billing procedures are implemented
6. Implements HAAD & DHA regulations by checking the required information, communicate with authorization to acquire product approval and issuing penalties for the interrupted members
7. Timely Service: Ensures work gets done as fast as possible within the established guidelines regardless of whether the daily workload is heavy or light.
8. Ensures that turnaround time for POS and policy issue is maintained
9. Ensures that systems and procedures are applied to implement what is already planned
10. Assists Senior to complete reports of policy issuance (System, communication with third party and client communication)
11. Issue Certificate of Insurance for all types of certificates (JAFZA, HAAD, DHA, Travel and Continuity Certificates)
12. Receives medical cards, check quality and release to the client as per company procedure
13. Processes daily clients query like member list, SOA, coverage letters, etc.
14. Updates regulatory with product registration “when it’s required” for DHA & HAAD and other emirates if mandated
15. Updates regulatory with Member registration DHA & HAAD and other emirates if mandated
16. Processes policy suspension, activation and termination with client, other departments and TPA’s
17. Checks the minimum requirements for policy issuance (Group & Individual) to be eligible for the coverage
18. Checks the minimum requirements for Endorsements to be eligible for the coverage
19. Ensures full compliance at all times of POS department with internal controls and audit requirements

Qualifications and Education Requirements

1. Bachelor’s degree in related courses
2. Working knowledge of general practices for medical insurance procedures

Skills and competencies

1. Computer literate with superior skills in Microsoft Word, Excel, and PowerPoint
2. Strong oral and verbal communication skills
3. Sound interpersonal skills at all organizational levels with the ability to establish rapport with personnel across a wide variety of areas
4. Goal oriented with an ability to work under minimal supervision
5. Superior attention to detail with the ability to take ownership of issues / projects and see them through to resolution, implementation, and completion with minimal supervision