Job Description:
Interpret and implement health insurance regulations, policies, circulars, and tariff rules, aligning them with internal
SOPs and advising relevant departments.
Maintain compliance registers, circular logs, and gap analyses; plan and document compliance audits and corrective actions.
Act as the primary liaison with health authorities, manage regulatory submissions, inspections, remediation plans, and
licensing renewals.
Oversee TPAs and third parties through SLAs, KPIs, audits, and compliance attestations, including claims and data handling.
Monitor and support investigations into Fraud, Waste & Abuse (FWA) and oversee regulator-escalated complaint resolution.
Ensure compliance with healthcare data privacy, security, retention, and cross-border transfer requirements.
Review and audit medical insurance operations to ensure adherence to approved terms, benefits, and regulatory
requirements.
Manage regulatory reporting calendars and ensure accurate, timely submission of all mandatory reports.
Job Requirements:
Bachelor’s in Business, Law, or Healthcare Management
Minimum 5-10 years experience working in Compliance roles specifically within a Health Insurance Company in the U.A.E.
Preferred Certifications:: ICA (International Compliance Association) or CFE (Certified Fraud Examiner)
Fluency in Arabic is a must