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Healthcare Audit Executive

Axa Life Insurance

Posted on October 9, 2019

3 - 4 years Dubai - United Arab Emirates

Any Graduation. Any Nationality

Opening 01

Job Description

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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.
Main Responsibilities:
You will:
• Identify the unfavorable trends in medical practice of the providers;
• Communicate identified issues and recommendation for improvement with the FWA Process manager;
• Ensure compliance with legal and regulatory claims management, liaising with compliance and legal to ensure the fulfillment of regulatory requirements;
• Liaise with other FWA Unit to develop Audit campaign on targeted providers improve and develop Audit criteria to expand the current audit activities;
• Support FWA analyst through clinical validation of the analysis;
• Report audit findings in a constructive approach to ensure best outcomes from the performed campaign;
• Identify areas of Gaps caused by current processes, report it for better controlled processed;
• Onsite File review for cases reported by the Medical Board team of possible document manipulation/ fraud;


Insurance

Accounts / Taxation / Audit / Company Secretary

Desired Candidate Profile

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Minimum Requirements:
• Proficient Knowledge of the Country s healthcare Insurance market;
• Proficient Knowledge of GCC countries healthcare providers trends and behaviors;
• Proficient Knowledge of the various GCC countries legislations and regulations;
• Sound Medical Knowledge and claims adjudication;
• Coding certification;
• Preferably Audit certification;
• Completed Bachelor Degree in Paramedical Courses like Nursing, Physical Therapy, Pharmacy, Medicine and Medical Technology.
• At least 3 years experience in a similar role in Healthcare Audit with coding experience.

Keywords

Healthcare Audit Executive

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Axa Life Insurance


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