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Riyadh

    Senior Anti Fraud Officer - Riyadh, المملكة العربية السعودية - Allianz Partners

    Allianz Partners
    Allianz Partners Riyadh, المملكة العربية السعودية

    تم العثور عليها في: Talent SA C2 - منذ 5 أيام

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    دوام كامل
    وصف
    Senior Anti-Fraud Officer that handles Fraud Medical Management tasks that conform to regulatory and Nextcare standard procedures by effectively managing priorities and communication externally in the medical filed.
    • Follows a data repository maintaining all reconciliation details of all providers (Provider/Month/Initial Rejection Vs. Final Rejection of current & previous)
    • Builds up a data repository to maintain Fraud Management data derived from providers based on the currently implemented Fraud Management set-up.
    • Abides by the target (Fraud recuperation amounts) and set dates to perform the allocated tasks accordingly.
    • Issues Monthly statistical reports to show the progress of Anti-Fraud Management.
    • Reviewing Claims & Approvals.
    • Providing suggestions.
    • Participate in Fraud Examination.
    • Participate in collecting Data & Investigation .
    • Ensures close, professional and efficient relations with existing Nextcare's provider networks.
    • Ensures timely collection of credit notes from related stakeholders.
    • Collaborates with the other departments (Processing Department Network Department, Claims Department, Direct Clients Relations, Reconciliation Team, Payment Releasing, and Finance Department) to support daily operations, hands-on assistance, mentoring, and training as necessary.
    • Ensures compliance with shareholders requirements
    • Maintains cordial working relationship with the other functions with the department.
    • Bachelor's Degree; Medicine and surgury
    • 2+ years of relevant experience.
    • Advanced knowledge in accounting software's ; Experience working with database is a plus.
    • Legally permitted to work in the country of operations.
    • Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills
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