Manager - Claims Integrity

Bupa Arabia
Saudi Arabia
Workplace: OnsiteFull timeFunction: Insurance & ActuarialExperience: 2+ yearsEducation: bachelorsSkills: ["Analytical","Investigative","Documentation","Problem-solving","Stakeholder coordination"]

Review and analyze FWA-related cases, alerts, and claims patterns to support accurate assessments and evidence documentation. Identify suspicious provider/member behaviors and emerging market trends, then negotiate and substantiate recoveries with provider relation teams. Produce reports for escalation to regulators, and provide feedback to improve Claims Integrity controls, detection logic, and operational processes.

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FursaFursa
Bupa Arabia
Bupa Arabia
6 days ago

Manager - Claims Integrity

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Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI
Last checked: 4 hours agoStatus: Live
Reposted: similar role first listed 6 days ago

Job Summary

Review and analyze FWA-related cases, alerts, and claims patterns to support accurate assessments and evidence documentation. Identify suspicious provider/member behaviors and emerging market trends, then negotiate and substantiate recoveries with provider relation teams. Produce reports for escalation to regulators, and provide feedback to improve Claims Integrity controls, detection logic, and operational processes.
Location: Saudi Arabia
Workplace: Onsite
Employment Type: Full time
Job Function: Insurance & Actuarial

Key Responsibilities

  • •Review FWA-related cases, alerts, claims patterns, and suspicious provider/member behaviors to assess claims details, medical justifications, billing patterns, and evidence.
  • •Document findings to support decisions, recoveries, escalations, or further review.
  • •Arrange and negotiate collected evidence with the provider relation team to support the needed recovery and target forecasting.
  • •Analyze repeated claims behaviors and emerging FWA patterns to recommend new controls, rules, and process changes.
  • •Support recovery follow-up and coordinate with stakeholders to ensure outcomes are actioned, providing feedback for operational gap reduction and reduced false positives.

Key Requirements

  • •2 years medical practice and insurance experience.
  • •Analytical and investigative skills to identify suspicious patterns, emerging market trends, and potential control gaps.
  • •Strong documentation skills to prepare case summaries, evidence packs, findings, and decision-support inputs.
  • •Problem-solving skills to provide practical feedback for improving Claims Integrity controls, detection logic, and operational processes.
  • •Bachelor's degree in Medicine (M.B; B.S./M.D or equivalent), with understanding of claims integrity, FWA, medical audit, claims operations, or healthcare insurance controls.
Experience:2+ yearsInsuranceHealthcareClaims integrityFWA
Education:Bachelor's in Medicine
Skills:AnalyticalInvestigativeDocumentationProblem-solvingStakeholder coordination
Tech Stack:Claims systemsCase management toolsDashboardsExcelReporting toolsReporting platforms

Company Brief

Bupa Arabia
Provides health insurance products and managed healthcare services in Saudi Arabia for individuals and corporate clients. The company focuses on coverage administration, medical network access, and digital health support for members.
Industry: Health Insurance (Payers)
Company Size: Large (251 to 1,000 employees)
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: Jeddah, Saudi Arabia
Founded: 1997
WebsiteLinkedIn