Healthcare Audit Executive

AXA Cooperative Insurance – KSA

Job Purpose: To be responsible for performing providers Audit Campaign, and identifying unfavorable trends in providers billing, maximize audit findings and recovery through providing solid audit ground.
Main Responsibilities:

  • Identify the unfavorable trends in medical practice of the providers;
  • Communicate identified issues and recommendation for improvement with the FWA Process manager;
  • Ensure compliance with legal and regulatory claims management, liaising with compliance and legal to ensure the fulfillment of regulatory requirements;
  • Liaise with other FWA Unit to develop Audit campaign on targeted providers improve and develop Audit criteria to expand the current audit activities;
  • Support FWA analyst through clinical validation of the analysis;
  • Report audit findings in a constructive approach to ensure best outcomes from the performed campaign;
  • Identify areas of Gaps caused by current processes, report it for better controlled processed;
  • Onsite File review for cases reported by the Medical Board team of possible document manipulation/ fraud;

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