drjobs Performance Analyst العربية

Performance Analyst

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1 Vacancy
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Jobs by Experience drjobs

Not Mentionedyears

Job Location drjobs

Ras Al Khaimah - UAE

Salary drjobs

Not Disclosed

drjobs

Salary Not Disclosed

Nationality

Emirati

Gender

Male

Vacancy

1 Vacancy

Job Description

Roles and responsibilities

ob Responsibilities / What you do:

  • Fraud Abuse and Waste detections and prevention from Medical providers for allocated regions/countries
  • Data mining and data analysis are required for conducting investigations on provider claims.
  • Support and drive the savings target strategy as set by the Global head of MPM
  • Review files, gather information, collect evidence to detect fraud and abuse on claims
  • 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
  • Participate in onsite Audits, in-house claims audit and Mystery shopping campaigns
  • Support the Medical Provider Performance Manager with all administration and support tasks to drive Fraud detections and prevention.
  • Assesses the scope and determine the methodology needed to carry out an efficient investigation.
  • Prepare comprehensive investigative reports and analysis
  • Collaborates and communicates internally with associated department’s ie legal, finance, claims operations as well as external clients and Providers.
  • Consults with legal and regulatory authorities for cases that may involve legal action.
  • Manages and ensures generation of periodic dashboards
  • Participates in specialized projects and assignments related to procurement, as required.
  • Maintains provider relationship in coordination with MPM team
  • Uses judgment, diplomacy and confidentiality with respect to the complete procurement process, ensuring integrity.
  • Preserves the reputation of company, beneficiaries, payers and all other parties Involved. Participates in specialized projects and assignments related to procurement, as required.

Key requirement / What you bring:

  • Medical Background (MBBS doctor/Nurse/Paramedic)
  • Coding Certification like CPC(Certified professional Coder), CPMA (Certified Professional medical Auditor, COC (Certified Outpatient Coder), CCS (certified Coding Specialist)
  • Work experience in insurance industry with claim cycle management
  • Expertise is excel, power BI, data analytics
  • Expertise in general industry trends.
  • A thorough knowledge of the various types of insurance fraud and the strategies and techniques used in their investigation and of federal and state regulations
  • Strong interpersonal/relationship skills.
  • Excellent written and verbal communication skills used for interviewing and corresponding with claimants, attorneys, doctors, law enforcement, etc.
  • 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.
  • Ability to adapt, meet the changing demands of work environment, any delays or other unexpected demands.
  • Ability to treat people with respect under all circumstances, instill trust in others besides upholding the values of organization.
  • Ability collaborate and work with internal and external colleagues to successfully complete the defined tasks and provide superior customer service.

Desired candidate profile

  • Analytical Skills:

    • Strong ability to analyze large sets of data, identify trends, and interpret performance metrics to make informed decisions.
    • Proficiency in using data analysis and business intelligence tools (e.g., Microsoft Excel, Power BI, Tableau, Google Analytics, SQL).
  • Strategic Thinking:

    • Ability to think strategically and align performance goals with the company’s broader objectives and vision.
    • Capability to forecast performance trends and make adjustments to strategies to maintain growth and efficiency.
  • Leadership and Team Management:

    • Excellent leadership skills to guide teams toward achieving performance goals. Ability to motivate and inspire employees to perform at their best.
    • Experience in managing cross-functional teams and driving initiatives across departments.
  • Project Management:

    • Strong project management skills to oversee performance improvement initiatives, ensuring that they are completed on time and within budget.
    • Ability to prioritize tasks, manage resources, and monitor progress.
  • Communication Skills:

    • Strong verbal and written communication skills to present performance data, influence decision-makers, and provide feedback to teams.
    • Ability to effectively communicate with senior management, department heads, and employees to ensure alignment on goals and initiatives.
  • Problem-Solving and Decision-Making:

    • Ability to identify and address performance issues quickly and effectively.
    • Capable of making data-driven decisions that balance short-term objectives with long-term organizational goals.
  • Attention to Detail:

    • Careful attention to detail when evaluating performance data to ensure accuracy and precision in reporting.
    • Ability to spot small discrepancies or trends that may indicate larger performance issues.
  • Time Management:

    • Excellent time management skills to handle multiple performance-related tasks and initiatives simultaneously, ensuring that deadlines are met.
  • Change Management:

    • Ability to lead and manage change within the organization, ensuring that performance improvements are sustainable and well-received by staff.

Employment Type

Full-time

Company Industry

Accounting

Department / Functional Area

Performance Management

About Company

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