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.

1. 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.

1. 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.

1. 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.

1. 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.

1. 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