Specialist- Insurance Claims(UAE National Only)
1. Regulatory Framework Development and Compliance
- Spearhead the establishment, implementation, and periodic review of comprehensive healthcare regulatory frameworks in alignment with legal and industry standards.
- Oversee the licensing, compliance monitoring, and performance evaluation of stakeholders across the healthcare ecosystem.
- Ensure consistent enforcement of regulations and promote a transparent, accountable healthcare environment.
- Contribute to the formulation of policies and regulatory instruments that enhance healthcare system integrity and sustainability.
2. Stakeholder Management and Market Oversight
- Monitor payer and provider market participants to ensure adherence to established regulatory and operational requirements.
- Address stakeholder concerns, inquiries, and compliance issues in a timely and professional manner.
- Facilitate effective engagement with public and private healthcare entities to ensure smooth and compliant health insurance operations.
- Maintain strong relationships with internal and external stakeholders to promote coordination and policy alignment.
3. Organizational Oversight
- Lead and manage a multidisciplinary team responsible for regulatory, operational, and analytical functions within the Corporation.
- Ensure the efficient execution of departmental objectives and the integration of cross-functional initiatives.
- Participate in high-level leadership meetings and strategic planning forums with both public and private sector partners.
- Promote a culture of performance excellence, professional development, and continuous improvement.
4. Technology Governance and System Implementation
- Oversee the operation, maintenance, and enhancement of the eClaimLink system, ensuring data integrity, vendor compliance, and system reliability.
- Lead the implementation and operationalization of the Diagnosis Related Group (DRG) healthcare payment system to streamline claims and improve cost efficiency.
- Supervise technology vendors and ensure system developments align with regulatory and operational requirements.
- Support digital transformation efforts aimed at enhancing transparency, efficiency, and data-driven decision-making.
5. Data Science, Analytics, and Insight Generation
- Direct data science activities, including the extraction, analysis, and interpretation of large healthcare datasets to support strategic initiatives.
- Provide analytical insights and evidence-based recommendations to guide leadership decisions and regulatory interventions.
- Develop and maintain analytical tools and dashboards to monitor healthcare market trends and system performance.
- Ensure the responsible and ethical use of data in alignment with corporate governance and privacy standards.
6. Strategic Advisory and Executive Support
- Serve as a consultant and subject matter expert to the CEO, offering insights on health regulation, operations, and market dynamics.
- Contribute to strategic projects, policy formulation, and inter-agency initiatives to advance Dubai’s healthcare vision.
- Represent the organization in external meetings, committees, and forums to advocate for regulatory and operational best practices.
- Support executive decision-making through comprehensive reports, strategic briefs, and technical recommendations.
Qualifications
Minimum Qualification: Masters in related field
Minimum Work Experience: Min 8 years