Hiring for an Reputed Insurance Company based at Muscat, Oman.
Job Title: Supervisor – Claims Audit & Risk (Medical Insurance)
Job Purpose
We are seeking a medically qualified professional to support Quality Assurance within the medical insurance function, focusing on claims auditing, utilization review, and risk identification with exposure to fraud detection. The role is ideal for candidates with strong clinical and insurance experience looking to expand into fraud and audit leadership.
Experience in utilization review, pre-authorization, medical claims auditing, and exposure to fraud detection and abuse patterns…
Key Responsibilities
Perform detailed audits of inpatient and outpatient medical claims
Identify irregularities, billing discrepancies, and potential abuse patterns
Support investigations into suspicious claims and document findings
Conduct retrospective reviews and assist in recovery of overpayments
Apply clinical knowledge to evaluate treatme...