1. Senior Officer – Medical Audit
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.
- 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.
- 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).
2. Data Analyst (Insurance Industry Background)
Job Code: DA0321
The successful candidate will turn data into information, information into insight and insight into business decisions.
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.
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.
3. Individual Medical - Product Manager
- 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.
4. Claims Audit & Reconciliation officer
- 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.
5. Officer - POS Medical/ Production (Policy Owner Services)
Job Code: OPOS1121
Role and Responsibilities
- Assists POS personnel in the operation
- Controls expenses of the department in areas such as equipment needed, forms, stationery, telephone, fax charges, etc.
- Ensures that company standards are met and kept up to date
- Ensures that POS comments are properly documented by self and all POS personnel in chronological and concise manner
- Ensures that daily and monthly billing procedures are implemented
- Implements HAAD & DHA regulations by checking the required information, communicate with authorization to acquire product approval and issuing penalties for the interrupted members
- Timely Service: Ensures work gets done as fast as possible within the established guidelines regardless of whether the daily workload is heavy or light.
- Ensures that turnaround time for POS and policy issue is maintained
- Ensures that systems and procedures are applied to implement what is already planned
- Assists Senior to complete reports of policy issuance (System, communication with third party and client communication)
- Issue Certificate of Insurance for all types of certificates (JAFZA, HAAD, DHA, Travel and Continuity Certificates)
- Receives medical cards, check quality and release to the client as per company procedure
- Processes daily clients query like member list, SOA, coverage letters, etc.
- Updates regulatory with product registration “when it’s required” for DHA & HAAD and other emirates if mandated
- Updates regulatory with Member registration DHA & HAAD and other emirates if mandated
- Processes policy suspension, activation and termination with client, other departments and TPA’s
- Checks the minimum requirements for policy issuance (Group & Individual) to be eligible for the coverage
- Checks the minimum requirements for Endorsements to be eligible for the coverage
- Ensures full compliance at all times of POS department with internal controls and audit requirements
Qualifications and Education Requirements
- Bachelor’s degree in related courses
- Working knowledge of general practices for medical insurance procedures
Skills and competencies
- Computer literate with superior skills in Microsoft Word, Excel, and PowerPoint
- Strong oral and verbal communication skills
- Sound interpersonal skills at all organizational levels with the ability to establish rapport with personnel across a wide variety of areas
- Goal oriented with an ability to work under minimal supervision
- 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