Specialist, Medical Audit ( UAEN with medical coding knowledge)
Skills
About This 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.
- 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.
Your resume, rewritten
for this exact role.
Sign up free — Base Career tailors your CV to this job description in 60 seconds.
01 / 05
Resume Tailored to This Job
Your keywords, structure, and story — rewritten to match this exact role and pass ATS filters.
Free · No card · 60 seconds
02 / 05
Cover Letter for This Role, Done
Job-specific cover letters written in Gulf professional tone — ready in seconds, not hours.
Free · No card · 60 seconds
03 / 05
See How Well You Fit This Role
AI match score with clear reasons — know your fit before investing time in the application.
Free · No card · 60 seconds
04 / 05
Apply in One Click
Autofill any application form on Workday, LinkedIn, Bayt, Greenhouse — with your tailored content.
Free · No card · 60 seconds
05 / 05
Track It. Follow Up at the Right Time.
Visual pipeline for every application with AI-timed follow-up reminders so nothing slips.
Free · No card · 60 seconds
2.2K+
Cover Letters & Follow-ups
1.8K+
Resumes Tailored
190.5K+
Jobs Tracked
Trusted by professionals at
Stop applying blindly.
Start getting hired.
Base Career automates the hardest parts of job searching — apply smarter, not harder.
AI Resume in 60s
Your resume rewritten for this exact role using the job description as the brief.
ATS-Optimized
Get past automated screening filters with the right keywords matched to each job.
Application Tracker
Track every job, follow-up, and interview in one visual kanban board.
Free plan · No credit card required