Team Leader

4 weeks ago

Muscat, Muscat, Oman MedNet Global Healthcare Solutions LLC Full time

Team Leader (Provide Audit & Claims Management) – MNSPC

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 an "Team Leader" This position will be responsible 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:

Control & Audit:

  • Monitor and review Claims audit and identify fraud and abuse trends to ensure the objectives are met in a timely and efficient manner and in adherence to procedural and contractual requirements.
  • Review the pending list of scheduled providers / incidents audit on regular basis and ensure targets are fully met and in line with fraud management and detection TAT.
  • Follow up the progress in coordination with a 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.
  • Reporting FWA to regulator.

Team Management support (when available):

  • 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 as per the operational targets and to reduce / eliminate the margin of errors during processes.

Business Reports:

  • Prepare & reports weekly/monthly/ quarterly/ annual business reports related to sampled data, positive findings, recovery process.
  • Prepare & reports regulatory reports for FWA as per pre-defined regulatory framework.
  • Prepare & reports payer reports for FWA and Utilization.
  • Prepare & reports / Reviews and signs off the full audit report prior to closure of the audits.

Your profile:

Minimum Qualifications & Requirements:

  • Bachelor's / master's degree holder in Medical - MBBS.
  • Certified professional Coder / Medical Auditor
  • Minimum of 3-5-years' experience gained within Oman/GCC Insurance market in a TPA or Insurance company /Health care provider.
  • Should have a proven positive track record of having worked in the capacity of a claim's specialist with FWA unit and FWA team management in the Oman/GCC market.
  • Excellent MS Office especially MS Excel. Experience of handling data analytic tool/s.
  • Critical Thinking, Negotiation skills, Analytical skills and Decision making
  • Excellent English language and communicational skills

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

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