MetLife Careers 2022: Dubai Employment Jobs News for FWA Analyst Vacancy in MetLife @www.metlife.ae

 

MetLife Careers Notification 2022-23:- MetLife, Dubai has released a new official job notification for the recruitment of FWA Analyst Jobs in Dubai, United Arab Emirates(UAE). In this Job Hiring, we have published here all important details for you about MetLife Careers, like Eligibility criteria, educational qualifications, work experience or skills required to apply for the latest jobs for MetLife Careers 2022.


All the details mentioned here in this employment News on our website www.neargovtjobs.com are taken from the official notification from the authorities or/and website of MetLife, which is www.metlife.ae. We are not responsible for any kind of discrepancies. Please check and read all the information carefully and apply accordingly to the guidelines mentioned in MetLife Career Notification.


The candidates who are qualified as per the requirement and meet other eligibility conditions set in the job hiring by MetLife may apply for this job opportunity in Dubai location and submit their filled up application form Online. Apart from this you should also check our latest and upcoming Dubai Jobs page as well to find out what active recruitments are going on in various private and government sectors in United Arab Emirates(UAE).

Keep Visiting us at www.neargovtjobs.com frequently to find out all kinds of current and Upcoming Government and Private Company Jobs nearby your city or town.

Highlights of the Current Job Openings in MetLife Careers @www.metlife.ae:

Name of Department/Organization: MetLife
Job Post Names: FWA Analyst
Job Location: Dubai
Job Type:
Jobs in United Arab Emirates(UAE)
Salary: AED 7250.00 per month
Official Website of MetLife: https://metlife.ae

 

MetLife Jobs Careers 2022: Job Hiring Description & Employment News for Vacant Posts in MetLife

Employment News for MetLife Careers 2022: If you are interested in applying for Dubai vacancies in MetLife, then read the present job alert and apply as explained in the official recruitment notification.

Find the following important details for MetLife Job Hiring:

  • MetLife Careers 2022: Eligibility & Educational Qualifications Required.
  • Age Limit to Apply for Vacancies in MetLife
  • MetLife FWA Analyst Careers: Monthly Salary and Pay Scale details for Current Vacancies in MetLife, Dubai
  • Selection Procedure for FWA Analyst Post in MetLife.

 

MetLife Job Hiring for FWA Analyst Vacancy in Dubai – Full Job Description

Read below job description for latest job opportunities in MetLife, Dubai. Apart from applying the present jobs in MetLife Careers you may apply for jobs in other notable organizations and companies in Dubai, UAE. Visit the official website for the full information about the latest career opportunities in MetLife.


Job Description:

JOB PURPOSE:

Will be responsible for investigate claims / actions of potential healthcare fraud, waste & abuse activities (which includes onsite audit visits) and assist in educating & alerting the team members & stakeholders of possible FWA cases & trends by meeting or exceeding the set quality standard; delivering results in a timely and consistent manner, meeting all department quality and production goals and remaining current with all applicable business and audit processes.

 


JOB DESCRIPTION:

The specific duties in this role will include, but not limited to:

  • Conduct daily reviews & investigations on flagged potential fraud, waste, & abuse cases and take corrective measures.
  • Perform data analysis to detect spikes, trends, and abnormalities in provider behavior.
  • Develop new rules and hypothesis and enhance & optimize the existing rules & hypothesis to detect potential fraud, waste, and abuse and prevent future FWA.
  • Report daily production and findings in the respective tool.
  • Share findings of positive FWA cases with stakeholders to ensure prevention, avoidance or recovery.
  • Update Claims Team, Pre-Approvals and Network on new FWA trends and educate FWA handling to reduce unnecessary claims payment.
  • Review internal claims data/reports to analyze provider performance and thereby to detect and prevent incorrect coding, abuse and fraudulent billing practices to keep claims cost control.
  • Prepare claims samples and supporting documentation for the on-site review and to conduct on-site provider claims & quality audit to ensure proper coding & billing practices and compliance to contractual obligations.
  • Support the recovery process from the provider which is initiated based on the FWA investigation & Provider Audit findings.
  • Maintains, communicates, tracks, and trend audit results and report findings according to designated timelines.
  • Display detailed understanding of standard claim / review processes and work flows, providing consistency and appropriate detail in alignment with all policies & procedures, business rules, and overall departmental guidelines.
  • Extend support in reviewing internal reports to analyze provider performance, sampling, and provider on-site audit.
  • Maintain consistent and quality production standards with consideration around specific audit and turnaround expectations.
  • Collaborate, coordinate, and communicate across departments and stakeholders.
  • Ensure compliance with local regulatory requirements and regulations.
  • Demonstrate Company’s Core Competencies and values held within.

 


Key Responsibilities:

  • ROI & Customer Centricity: Support in performing Provider Audit to ensure medical necessity, detection of fraud, waste and abuse & ensure services billed were performed, correct utilization of CPT codes, etc. A savings target will be assigned for this role in line with the organizational roadmap.
  • Internal Partnership: Develop a feedback mechanism in coordination with Claims Manager to ensure adjudicators are aware of the FWA trends and educate them with FWA handling thus support in the development need of adjudicators and similarly developing a mechanism to provide feedback on providers behavior to Medical Network Team, Pre Approval Team and Case Management Team
  • P & L : Identification of risk, fraud, claims abuse via data analytics and information sharing with relevant teams to ensure such claims are controlled resulting in a positive impact on P & L. Similarly identification of cost effective methods for claims and pre approval for specific procedures
  • Strategy : Be responsible to support the TPA Audit process to drive results to identify trends for fraud, waste and abuse and to ensure operational efficiency & cost containment in the claims administrative process.

 


COMMUNICATIONS & WORKING RELATIONSHIPS:

Internal: Claims Manager, Medical Network & Relationship Manager, Enabling Function Manager, EB Sales Managers, and Medical Liaison Manager

External: Healthcare Providers, Policyholders, regulatory authorities.

 


QUALIFICATIONS, EXPERIENCE, & SKILLS:

  • Bachelor’s degree preferably in medical related field or equivalent combination of education and applicable work experience.
  • Coding certification from a relevant association (AAPC, AHIMA etc) recognized by local regulatory authorities (DHA, DoH etc); preferably as a certified medical auditor.
  • 2 – 3 years of experience with provider & payer to have a strong knowledge of billing patterns and coding
  • Strong record of success in data analytics and identification of fraud patterns from providers
  • Possess skills to develop creative solutions for medical quality management
  • Possess skills for feedback mechanism for different stakeholders
  • Strong understanding of medical terminologies (diagnosis, services etc) is required.
  • In depth knowledge and understanding of insurance terminologies, medical policy terms and conditions stipulated in policy contracts.
  • A graduate degree, MBA degree or other advance degree is preferred.
  • A nursing degree or Pharmaceutical or Medical degree will be of value however not mandatory.

How to Apply for Careers in MetLife?

Interested & Eligible candidates click the “apply online” link as given below and visit the actual job listing page on the website of MetLife where you would find online application form to submit your application to apply for FWA Analyst post at the earliest possible.

Find apply link below for application form for MetLife Job Hiring; read it carefully and apply accordingly.

MetLife Career Notification, Application Form for FWA Analyst:

Apply Online for FWA Analyst Vacancy in MetLife

 

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