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Claims Fraud Specialist

3 weeks ago

Muscat, Muscat, Oman beBeeFraud Full time 80,000 - 120,000

Global Insurance Companies require experienced professionals to identify and prevent medical claim fraud.

Job Summary:

The ideal candidate will conduct thorough audits of inpatient and outpatient claims, flagging irregularities and investigating suspicious claims to recommend recovery actions. They will leverage clinical and policy knowledge to assess treatment validity, collaborate with providers and internal teams to detect fraud, and analyze claims data to identify trends and generate insights.

A key aspect of this role is to maintain dashboards for savings, turnaround time, and fraud indicators. The successful candidate will also support provider evaluation, credentialing, and negotiations, recommending exclusion of non-compliant providers and driving automation and SOP improvements for fraud detection.

Qualifications & Certifications:
  • M.B.B.S. (Bachelor of Medicine, Bachelor of Surgery) or B.A.M.S. (Bachelor of Ayurvedic Medicine and Surgery)
  • Certification in Fraud Detection, Health Insurance, or Risk Management
Experience:
  • Minimum 5–7 years in medical claims, audits, or insurance fraud detection
  • Proven track record of successful fraud investigations and recoveries
  • Experience working in GCC healthcare insurance systems is preferred

For success in this role, the candidate should possess strong analytical skills, attention to detail, and excellent communication and collaboration skills. The ideal candidate will be a strategic thinker who can drive results and make a meaningful impact on the organization.