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Compliance Officer - Medical Insurance

métier - Strategic HR Solutions
Abu Dhabi Emirate, UAE
Full Time
Mid
4 weeks ago
UAE health insurance regulationsDHA regulationsDOH regulationsMOHAP regulationsCBUAE regulationsCompliance audits
Free

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UAE health insurance regulationsDHA regulationsDOH regulations
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Key Responsibilities

  • Ensure end to end regulatory compliance across medical insurance operations including underwriting, pricing, claims, operations, IT, data privacy, and fraud management
  • Monitor, interpret, and implement UAE health insurance regulations, circulars, and tariff rules across all departments
  • Maintain compliance obligations register and track regulatory updates from CBUAE, DHA, DOH, and MOHAP
  • Act as the primary liaison with regulatory authorities and manage inspections, audits, and regulatory submissions
  • Oversee compliance audits, documentation, and maintain audit readiness across all functions
  • Establish and manage compliance oversight for TPAs and third party vendors including SLAs, KPIs, and audit rights
  • Monitor and investigate Fraud, Waste & Abuse (FWA) cases in medical claims
  • Ensure compliance with healthcare data privacy, confidentiality, and cross border data regulations
  • Review SOPs, policies, and internal procedures to ensure regulatory alignment
  • Manage escalated complaints, regulatory disputes, and enforcement responses
  • Support regulatory reporting, license renewals, and compliance reporting to senior management

Requirements

  • Bachelor’s degree in Business, Law, Healthcare Management, or related field
  • Minimum 5–10 years of experience in compliance within a health insurance company in the UAE
  • Strong knowledge of UAE insurance and healthcare regulations (DHA, DOH, MOHAP, CBUAE)
  • Experience in regulatory audits, compliance monitoring, and reporting
  • Preferred certifications: ICA (International Compliance Association) or CFE (Certified Fraud Examiner)
  • Experience in medical insurance operations including claims and underwriting compliance
  • Arabic language is preferred

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