Healthcare Audit Manager

Job Description

Who we are

GIG Group reported consolidated assets of US$4.01 billion and a net profit of US$84 million for the year 2024.

It follows a decentralized model, empowering local leadership teamsmany of whom have over 20 years of tenurewith trust and accountability. Fairfaxs culture, rooted in its guiding principles, is reflected across all of its subsidiaries.

It also holds a 50% stake in GIG Saudi. The companys strategic priorities are centered around regional growth, customer experience, and digital transformation.

Passionate about customer feedback, the company is constantly evolving to become the regions digital insurer of reference, operating in a responsible and sustainable way.

Job purpose:

To be responsible for performing providers audit campaign, and identifying unfavorable trends in providers billing, maximize audit findings and recovery through providing solid audit ground.

Audit utilization payment integrity and collaborate with internal stakeholders to promote corrective measures.

Investigate open file cases, high value claims and suspect malpractice.

• Develop and execute comprehensive audit plans for healthcare insurance operations across UAE, Bahrain, Qatar, and Oman.
• Conduct audits of health insurance claims, provider billing practices, and policy compliance to ensure accuracy and regulatory adherence.
• Perform risk-based audits focusing on high-impact areas such as fraud detection, coding accuracy, and payment integrity.
• Ensure compliance with local healthcare regulations, insurance laws, and international standards.
• Stay updated on regulatory changes in each country and assess their impact on audit scope and procedures.
• Prepare detailed audit reports outlining findings, risks, and actionable recommendations.
• Present audit outcomes to senior management and collaborate on corrective action plans.
• Liaise with internal departments (claims, underwriting, provider relations) and external stakeholders (regulators, healthcare providers) to facilitate audit processes.
• Build trust and maintain open communication with audited entities to ensure transparency and cooperation.
• Identify and investigate suspicious or fraudulent claims and billing practices.
• Recommend improvements to internal controls and systems to mitigate fraud and abuse.
• Contribute to the development and refinement of audit methodologies and tools.
• Coordinate audit activities across multiple jurisdictions, ensuring consistency in audit practices and reporting.
• Adapt audit procedures to reflect country-specific healthcare systems and insurance frameworks.
• Participate in the review and development of new audit standards and procedures.
• Monitor industry trends and best practices to enhance audit effectiveness and efficiency.

Minimum requirements of the role:

Essential:

• Medical Degree (MBBS, or equivalent)
• Additional qualifications in insurance is advantageous.
• Certification as a Auditor in relevant standards (e.g., CPMA)
• Professional Experience
• Minimum 5 years of experience in healthcare auditing, preferably within Insurance/TPA.
• Proven experience conducting audits across multiple jurisdictions or healthcare systems.
• Regulatory Knowledge
• Familiarity with healthcare regulations and insurance frameworks in UAE, Bahrain, Qatar, and Oman.
• Strong Negotiations Skills.
• Strong Problem-Solving Skills
• Sound knowledge of medical claims adjudication.

Desirable:

• Strong knowledge of medical coding claims processing, and clinical documentation.
• Ability to analyse complex data sets and identify patterns of non-compliance or fraud.
• Proficiency in planning, executing, and reporting on audits.
• Skilled in using audit tools and methodologies aligned with healthcare standards.
• Excellent written and verbal communication skills for preparing audit reports and presenting findings.
• Ability to communicate effectively with cross-functional teams and external stakeholders.
• High level of accuracy in reviewing medical records, billing data, and compliance documentation.
• Capable of identifying root causes of issues and recommending practical corrective actions.
• Experience leading audit teams and mentoring junior auditors.
• Strong organizational and project management skills.
• Commitment to maintaining confidentiality and ethical standards in handling sensitive healthcare data.