Manager - Claims Integrity

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

Perform detailed review and analysis of FWA-related cases, alerts, and claims patterns to support accurate assessments, evidence documentation, decision-making, and recovery follow-up. Investigate suspicious provider/member behavior, negotiate with provider relation teams for recovery, and escalate findings to regulators. Identify emerging abuse trends to improve detection logic and controls, while partnering with cross-functional stakeholders to action outcomes and strengthen Claims Integrity processes.

Loading

Loading job details...

Preparing the role view and application actions.

FursaFursa
Bupa Arabia
Bupa Arabia
6 days ago

Manager - Claims Integrity

✓ Verified Job

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

Source: Company careers pageValidated by: Fursa AI
Last checked: 4 hours agoStatus: Live

Job Summary

Perform detailed review and analysis of FWA-related cases, alerts, and claims patterns to support accurate assessments, evidence documentation, decision-making, and recovery follow-up. Investigate suspicious provider/member behavior, negotiate with provider relation teams for recovery, and escalate findings to regulators. Identify emerging abuse trends to improve detection logic and controls, while partnering with cross-functional stakeholders to action outcomes and strengthen Claims Integrity processes.
Location: Saudi Arabia
Workplace: Onsite
Employment Type: Full time
Job Function: Insurance & Actuarial
Seniority: Mid level

Key Responsibilities

  • •Review FWA-related cases, alerts, claims patterns, and suspicious provider/member behavior.
  • •Assess claim details, medical justifications, billing patterns, and supporting evidence to identify potential FWA concerns and document findings.
  • •Negotiate fraudulent cases with the provider relation team by arranging and presenting collected data/evidence for needed recovery decisions.
  • •Analyze repeated claim behaviors, provider trends, market practices, and emerging FWA patterns to identify new control needs.
  • •Support recovery follow-up and process improvement by coordinating stakeholders and feeding back on operational gaps, false positives, and improvement opportunities.

Key Requirements

  • •2 years of 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.
  • •A Bachelor's degree in Medicine (M.B; B.S./M.D or equivalent).
  • •Understanding of claims integrity, FWA, medical audit, claims operations, or healthcare insurance controls.
Experience:2+ yearsInsuranceHealthcareMedical practice
Education:Bachelor's in Medicine
Skills:AnalyticalInvestigativeDocumentationProblem-solvingCommunication
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