Bupa - Dubai - Conduct medical audits of healthcare service providers on a regular basis and investigate suspected health insurance misuse and abuse : To manage the process of retrospective / concurrent clinical and financial audits of billing practices of high risk or high spend providers To develop pipelines of target providers. To support in concurrent case review and case management To implement processes to recover overcharging To support provider contractors in negotiating recoveries . To develop the providers audit process with BGME service partners . To work with operational areas to recommend best practice in processing claims against providers To provide clinical support and guidance to fraud investigation activity To provide clinical support and guidance to health risk analysis activity Role Responsibility Conduct data driven on-site audits of healthcare service providers, checking and evaluating accurately the medical record and related documents of the members to assess any...
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