Specialist, Medical Audit ( UAEN with medical coding knowledge)
Job Fit Check
Base Career helps you apply smarter for this job.
Key skills for this role
About the Role
Core Responsibilities: Conduct detailed audits of home care, LTC, and dental claims to assess their validity, appropriateness, and compliance. Monitor patterns of utilization and identify cases of overuse, underuse, or misuse of healthcare services.
Key Skills for This Role
Full Job Posting
Core Responsibilities
- Conduct detailed audits of home care, LTC, and dental claims to assess their validity, appropriateness, and compliance.
- Monitor patterns of utilization and identify cases of overuse, underuse, or misuse of healthcare services.
- Draft comprehensive audit reports, summarizing findings, identified risks, and recommended corrective actions.
- Implement preventive measures and process improvements to minimize financial losses due to fraudulent or unnecessary claims.
- Liaise with healthcare providers to verify claim-related concerns and request supporting documentation when required.
- Participate in case reviews and assist in claim adjudication processes based on audit findings.
- Coordinate with medical and legal teams to support investigations and dispute resolution cases.
- Adapt audit techniques and strategies based on new developments in home care, LTC, and dental healthcare services.
- Provide technical input in policy enhancements related to claims processing, billing guidelines, and audit requirements.
- Receive and review complaints regarding questionable medical claims and investigate their validity.
- Conduct on-site provider audits, ensuring adherence to quality and regulatory standards.
Quality & Excellence Management
- Monitor adherence to local and international healthcare regulations in medical audit processes.
- Develop and implement quality assurance measures to enhance the accuracy and reliability of audits.
- Coordinate with quality management teams to improve service delivery and provider compliance.
- Implement standardized procedures for documentation and record-keeping in medical audits.
- Contribute to the continuous improvement of audit workflows and methodologies.
Preferred Educational Qualifications And Professional Certifications
- Bachelor’s Degree in Medicine, Dentistry, Pharmacy, Nursing, Physiotherapy, Healthcare Management, or a related field.
- Master’s Degree in Healthcare Management, Public Health (MPH), Business Administration (MBA - Healthcare Focus), or Insurance & Risk Management, or a related field is preferred.
- Professional certifications such as Certified Healthcare Auditor (CHA), Certified Fraud Examiner (CFE), Certified Professional in Healthcare Quality (CPHQ), or equivalent is advantageous.
Experience
- A minimum of 2-4 years of experience in medical auditing, claims review, fraud detection, or healthcare risk management within the insurance or healthcare industry.
Apply for this job in 1 click
Skip the repetitive application forms
Install the Base Career Chrome Extension and autofill job applications across major job boards with your profile.
Trusted by over 500,000 job seekers on Base Career
More from this employer
More jobs at The National Insurance Company – Daman
Coordinator, Commercial Strategy
Abu Dhabi, UAE
The National Insurance Company – Daman seeks a Coordinator for Commercial Strategy & Market Development to provide operational, research, and administrative support. This entry-level role offers exposure to commercial st
Assistant Manager, Reinsurance Operations
Abu Dhabi, UAE
DAMAN is hiring an Assistant Manager for Reinsurance Operations to administer ceded facultative and treaty reinsurance arrangements. The role involves accurate booking of reinsurance transactions, ensuring adherence to p
Coordinator, Data Privacy Office (UAEN - Ethraa)
Abu Dhabi, UAE
Daman is seeking a Coordinator for the Data Privacy Office to support data privacy and information governance operations. The role involves maintaining records, tracking compliance, and coordinating privacy initiatives.
Specialist, Authorisation ( Emirati Dentist)
Abu Dhabi, UAE
The National Insurance Company – Daman seeks a Specialist, Authorisation (Emirati Dentist) to facilitate dental authorization processes, evaluate requests, ensure compliance with medical policies, and coordinate with sta
Coordinator Health Strategy & Government initiatives
Abu Dhabi, UAE
The National Insurance Company – Daman is hiring a Coordinator to support the Medical Transformation team in Abu Dhabi. The role involves coordinating key government (DOH) initiatives and cost containment programs, with
Internship Opportunity for UAEN 2026
Abu Dhabi Emirate, UAE
The National Insurance Company – Daman offers an internship program for UAE Nationals, providing hands-on experience and professional development across multiple areas including HR, Finance, Legal, Data Analytics, Market
Manager, Software Development
Abu Dhabi, UAE
The National Insurance Company – Daman is seeking a Manager of Software Development to lead and oversee the development of innovative software solutions aligned with strategic objectives. The role involves formulating be
Manager, Underwriting (Medical)
Abu Dhabi Emirate, UAE
We are seeking an Underwriting Manager (Medical) to formulate underwriting strategies, implement innovative models, and ensure compliance-driven frameworks. You will oversee team development and collaborate with sales an
Coordinator, Commercial Strategy
Abu Dhabi, UAE
Assistant Manager, Reinsurance Operations
Abu Dhabi, UAE
Coordinator, Data Privacy Office (UAEN - Ethraa)
Abu Dhabi, UAE
Specialist, Authorisation ( Emirati Dentist)
Abu Dhabi, UAE
Coordinator Health Strategy & Government initiatives
Abu Dhabi, UAE
Internship Opportunity for UAEN 2026
Abu Dhabi Emirate, UAE
Manager, Software Development
Abu Dhabi, UAE
Manager, Underwriting (Medical)
Abu Dhabi Emirate, UAE