Medical Fraud Senior Analyst –Payment Integrity FWA Regional Team
On-siteRiyadh, Riyadh Region, Saudi Arabia
Riyadh, Riyadh Region, Saudi ArabiaOn-siteFull TimeSenior LevelLicense Or CertificationEnterprise
Full TimeSenior LevelLicense Or CertificationEnterprise
Job Summary
Medical Fraud Senior Analyst in Payment Integrity for the KSA region. Responsible for detecting and recovering FWA payments for non-network claims, performing prepay cost avoidance, monitoring spend, and developing solutions to prevent future overpayments. Collaborates with PI team members, Network, Medical Economics, Data Analytics, Claims Operations, Clinical partners, Product, and MIU to ensure regulatory compliance and timely PI claims review. Requires data analytics capability, strong organization, the ability to work with cross-functional teams across time zones, and fluency in Arabic and English.
Required Qualifications
- Minimum of 4 years of health insurance or health care provider experience
- Knowledge of claims coding, local regulatory rules and medical policy
- Medical/ paramedical qualification is a definite plus
- Fluency in Arabic and English
- Excellent verbal and written communication skills
- Ability to balance multiple priorities and work with global teams across time zones
- Strong attention to detail and data analytics experience
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