Specialist – Claims Anti FWA, MedNet, UAE

 For MedNet Global.

As a member of Munich Re the MedNet Group is a leading Third-Party Administrator across the MEA region. We are currently seeking to hire a “Specialist – Claims Anti-Fraud, Waste and Abuse Investigation” As a specialist in detecting, addressing, and preventing claims Fraud, waste and abuse you will be accountable for the success of this unit in its multiple cost containment, Quality management and Payment integrity initiatives. This position is responsible to manage the performance of direct reports aligned to the goals and initiatives of the organization in an efficient manner.
 

Your Role:

• Monitor and review Claims audit and identified fraud and abuse trends to ensure the objectives are met in a timely and efficient manner and in adherence to procedural and contractual requirements.
• Follow up the progress in coordination with respective Provider of complicated fraud and abuse incidents.
• Conduct periodic quality assurance on all assigned audits and recoveries done by the team to ensure compliance with applicable regulations and accuracy of information.
• Supervise and manage the performance of direct reports. Defines targets and work schedules for team members and guide them on expected level / over-achievement / under-achievement of performance.
• Conduct regular audits and random checks to ensure delivery timelines are met with as per the operational targets and to reduce / eliminate the margin of errors during processes.
• Identify training requirements of direct reports and provide regular and periodic feedback to the team on areas of important, observations, recommendations.
• Prepare & reports monthly/ quarterly/ annual business reports related to Fraud, Waste and Abuse (FWA).

Your profile:

• Bachelor’s / Master’s Degree holder in Medical / paramedical fields.
• Certified professional Medical Coder (CPC) 
• Certified professional Medical Auditor (CPMA)
• Excellent English language.
• Flexibility. Excellent interpersonal and communicational skills
• Strong leadership, planning and organizational skills
• Business Process Improvement skills and techniques.
• Computer Literacy (MS Word, MS Excel, MS PowerPoint)
• Experience of handling data analytic tool/s & Analytical skills
• Negotiation skills
• Critical Thinking and Decision making

Minimum Qualifications:

• Bachelor’s / Master’s Degree holder in Medical/ paramedical fields.
• Certified professional Medical Coder (CPC) 
• Certified professional Medical Auditor (CPMA)

Minimum Experience:

• Minimum of 3-5-years’ experience gained within UAE Insurance market in a TPA or Insurance company within FWA unit and FWA team management.
• Should have a proven positive track record of having worked in the FWA unit and FWA team management in the UAE market.

*Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunities employer.

https://mednet.referrals.selectminds.com/jobs/specialist-%E2%80%93-claims-anti-fwa-313

▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬

You may also submit your CV here >>>>>>>>

https://www.dubai-forever.com/submit-your-cv.html

 

 Take Action Now!

Order Your Customized CV!

Click on Your Level of Experience:

 

• Entry Level (0-2 Years Total Work Experience) --> http://www.dubai-forever.com/entry-level-resume.html

 

 

• Junior Professional Level (2 - 5 Years Work Experience) --> http://www.dubai-forever.com/professional-level-cv.html

 

 

• Mid Level Professionals (5 - 8 Years Work Experience) --> http://www.dubai-forever.com/mid-level-cv.html

 

 

• Senior Professional Level (8 - 15 Years Work Experience) --> http://www.dubai-forever.com/professional-level-resume.html

 

 

• Executive Level (CEO, CFO, COO, MD, VP, Director, Manager) --> http://www.dubai-forever.com/executive-level-resume.html