Medical Provider Performance - dubai - Nextcare

    Nextcare
    Nextcare dubai

    1 day ago

    Description

    This role involves conducting impartial and timely investigations into healthcare fraud and abuse against Allianz Group or its payers by members, providers, or other entities, while maintaining strong relationships with all parties.

    It requires creativity to obtain elusive case information and the ability to work independently with minimal supervision.

    Strong organizational skills are essential for managing a high caseload, along with the ability to exercise independent judgment and initiative.

    The investigator must have the analytical skills to assess and evaluate information critical to resolving complex with the Global head of Medical Provider Management (MPM) to set and support the achievement of savings targets.

    Develop and implement strategies for fraud, abuse, and waste detection and prevention among medical providers in assigned regions/countries.
    Monitor and review provider claims to detect inconsistencies and irregularities.

    Assess the scope and determine the methodology needed to carry out an efficient mining and data analysis for Providers under in onsite audits, in‑house claims audit, offsite audits with data trending and mystery shopping campaigns to assess provider compliance to ethical practices and to detect fraudulent activities.

    Document all evidence obtained in the investigation in order to substantiate meritorious claims, to deny unjustified claims, to recover inappropriate payments or to recommend action against responsible parties.

    Communicate findings and recommendations to the legal, finance, claims operations, and other associated departments, as well as to external clients and providers.

    Consult with legal and regulatory authorities as necessary, particularly in cases involving potential legal action.

    Ensure all communications and interactions are conducted with judgment, diplomacy, and confidentiality to maintain the integrity of the procurement process.

    Provide regular feedback to Medical Provider Performance Manager for the ongoing audit activities and provider the generation and review of periodic dashboards and other monitoring tools to track the effectiveness of fraud and abuse prevention measures.

    Maintain and strengthen relationships with medical providers in coordination with the MPM team.

    Represent the company's reputation and values, ensuring that all actions align with ethical standards and protect the interests of beneficiaries, payers, and other stakeholders.

    RequirementsMedical Background (MBBS doctor)Coding Certification (Preferred)Proven experience in fraud detection, data analysis, and investigative methodologiesStrong strategic planning and organizational skills.

    Effective communication and reporting skills.
    Ability to work collaboratively across departments.
    High level of integrity and professionalism in handling sensitive in Excel, Power BI, data analytics.

    A high degree of integrity, dependability, accountability and confidentiality is required for handling information that is considered personal and confidential.

    Ability to analyze data and interpret results.
    #J-18808-Ljbffr

  • Work in company

    Medical Provider Performance

    Only for registered members

    This role involves conducting impartial and timely investigations into healthcare fraud and abuse against Allianz Group or its payers by members, providers, or other entities, while maintaining strong relationships with all parties. It requires creativity to obtain elusive case i ...

    Dubai, Dubai د.إ90,000 - د.إ120,000 (AED) per year

    5 days ago

  • Work in company

    Medical Provider Performance Executive

    Only for registered members

    This position is responsible for conducting objective, fair, thorough, unbiased and timely investigations of healthcare providers for fraud, waste and abuse committed against Allianz group or its Payers by members, providers, or other entities whist monitoring best of relationshi ...

    Dubai, Dubai

    1 week ago

  • Work in company

    Medical Provider Performance

    Only for registered members

    Job Description · This role involves conducting impartial and timely investigations into healthcare fraud and abuse against Allianz Group or its payers by members, providers, or other entities, while maintaining strong relationships with all parties. It requires creativity to obt ...

    Dubai

    4 days ago

  • Work in company

    Medical Provider Performance

    Only for registered members

    This role involves conducting impartial and timely investigations into healthcare fraud and abuse against Allianz Group or its payers by members, providers, or other entities, while maintaining strong relationships with all parties. It requires creativity to obtain elusive case i ...

    Dubai

    6 days ago

  • Work in company

    Medical Provider Performance Executive

    Only for registered members

    This position is responsible for conducting objective, fair, thorough, unbiased and timely investigations of healthcare providers for fraud, waste and abuse committed against Allianz group or its Payers by members, providers, or other entities whist monitoring best of relationshi ...

    Dubai Full time

    1 week ago

  • Work in company

    Retail Performance Manager

    Only for registered members

    We are partnering with a globally recognised luxury retail organisation to appoint a Retail Performance Manager based in Dubai. This is a highly strategic position focused on strengthening commercial performance across a network of boutiques through data-led analysis, cross-funct ...

    Dubai

    1 week ago

  • Work in company

    Master Trainer

    Only for registered members

    The role is responsible for providing hands-on, on-site training to construction workers across various trades. · ...

    Dubai

    1 month ago

  • Work in company

    Senior Financial Analyst

    Only for registered members

    Date: Feb 24, 2026 · Location: · Dubai, AE · Company: Midis Group · Vendor: VMware · Req ID: 2961 · Job Title · Senior Financial Analyst · Job Scope · The Senior Financial Analyst is accountable for tracking the company's financial performance, analyzing business performance and ...

    Dubai, Dubai د.إ210,000 - د.إ420,000 (AED) per year

    1 week ago

  • Work in company

    Manager International Operations

    Only for registered members

    Desarrollar e implementar estrategias de marketing para el mercado regional, coordinando eventos y gestiones. · ...

    Dubai, Dubai

    1 month ago

  • Work in company

    Female Bollywood Dance Performers

    Only for registered members

    + Female Bollywood Dancers & MC (On-Site) LPS Brands is launching a Live Show. · + This is an on-site role with fixed pay, incentives, · and long-term opportunities for strong performers. · + Language Requirements: English & Hindi – mandatory, · Arabic – an added advantage. ...

    Dubai

    1 month ago

  • Work in company

    Oracle DBA

    ITHR Technologies Consulting

    · Database Administration: · Install, configure, and upgrade Oracle database software and manage patches/updates. · Manage and monitor Oracle database environments, ensuring high availability and performance. · Perform regular database backups, restore operations, and disaster r ...

    Dubai, United Arab Emirates

    1 week ago

  • Work in company

    Manager International Operations

    Only for registered members

    +Job summaryDevelop and implement of DET's regional business-to-business Travel&Trade marketing strategy, operating model and objectives; assist the regional relationship building activities by coordinating events. · +Monitor junior team's performance and issue periodic reports t ...

    Dubai

    1 month ago

  • Work in company

    Mobile Technician

    Only for registered members

    Diagnose and troubleshoot mobile equipment malfunctions using advanced diagnostic tools to ensure optimal performance. · ...

    Dubai

    1 month ago

  • Work in company

    F&I Manager

    Only for registered members

    An Automotive Finance and Insurance (F&I) Manager oversees the finance and insurance department managing a team of F&I executives. · ...

    Dubai

    1 month ago

  • Work in company

    Call Centre Manager

    Only for registered members

    Oversee daily operations ensuring the team meets performance targets while providing exceptional customer service. · ...

    Dubai

    2 weeks ago

  • Work in company Remote job

    Financial Analyst

    Only for registered members

    As a Financial Analyst, you will be responsible for collecting, analyzing and interpreting the company's financial data to support management in budgeting forecasting and performance evaluation. · ...

    Dubai, Dubai

    1 month ago

  • Work in company

    Front Office Manager

    Only for registered members

    Responsible for all front office functions and staff. · ...

    Dubai

    1 month ago

  • Work in company

    Laundry Technician

    Only for registered members

    The commercial Laundry Equipment Technician is responsible for the installation maintenance and repair of commercial laundry equipment ensuring optimal performance and longevity. · ...

    Dubai

    3 weeks ago

  • Work in company

    After Sales Support

    Only for registered members

    Plan the activity of the team related to policy creation functions and allocates tasks to his team members. · Motivates his team by providing clear targets and directives. · ...

    Dubai

    1 month ago

  • Work in company

    Mechanical Engineer – 12 Months Contract

    Only for registered members

    Job summary · A proactive and experienced Mechanical Engineer is sought to represent a client in delivering a high-end Private Island Chalet Project. · Review mechanical design submissions. · Supervise installation and commissioning of mechanical systems. · ...

    Dubai, Dubai

    1 month ago

  • Work in company

    Electrical Engineer – 12 Months Contract

    Only for registered members

    We are looking for an Electrical Engineer to oversee electrical engineering aspects from planning and design to execution and handover of a prestigious Private Island Chalet Project ensuring quality safety luxury standards are met. · Review approve electrical design submissions s ...

    Dubai, Dubai

    1 month ago

Jobs
>
Dubai