IP & OP Claims Auditor

Job Description

We are looking for a highly analytical IP & OP Claims Auditor to ensure accuracy, compliance, and revenue integrity across all insurance claims. This role is pivotal in minimizing denials, optimizing reimbursement, and maintaining alignment with UAE payer regulations and coding standards.

Key Responsibilities

• Audit Inpatient (IP) and Outpatient (OP) claims for accuracy, completeness, and compliance
• Validate ICD/CPT coding against clinical documentation
• Identify and rectify billing discrepancies, errors, and revenue leakages
• Review claims prior to submission to ensure clean claim rates
• Analyze and manage denials, rejections, and resubmissions
• Conduct periodic internal audits and compliance checks
• Ensure adherence to UAE insurance policies, DHA guidelines, and payer protocols
• Collaborate with coders, billing teams, and clinicians for documentation improvement
• Generate audit reports with actionable insights for process optimization

Eligibility Criteria

• ✔ Mandatory: Certified Medical Coder or Medical Doctor
• ✔ Proven UAE experience in claims auditing / RCM / insurance domain
• ✔ Strong expertise in ICD/CPT coding systems and auditing practices
• ✔ In-depth knowledge of UAE payer requirements and claim adjudication processes
• ✔ Experience handling IP & OP claims auditing, denials, and reconciliation

Core Competencies

• Strong analytical and auditing skills
• High attention to detail and compliance orientation
• Ability to identify patterns in claim denials and revenue gaps
• Effective cross-functional communication
• Data-driven decision-making mindset

Why Join Us?

• Be part of a leading healthcare institution in Dubai
• Work in a high-impact revenue cycle environment
• Exposure to advanced audit systems and healthcare compliance frameworks
• Growth opportunities within a structured healthcare ecosystem