JOB OVERVIEW
Reporting to the Fraud Investigations Lead, the Fraud Analyst is a specialized, forensic investigator responsible for identifying, analyzing, and mitigating financial leakage stemming from fraudulent activities, waste, and abuse across regional healthcare networks. The Analyst owns the end-to-end investigation of suspicious medical portfolios, profiles high-risk healthcare providers, and compiles formal fraud assessment reports for executive stakeholders.
This role combines clinical-financial forensics with risk engineering, designing proactive operational controls, developing anti-fraud awareness materials, and collaborating closely with Global Operations to ensure the consistent application of the corporate Fraud Framework.
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KEY RESPONSIBILITIES
Responsibilities will include, but are not limited to, the following:
- Identify & investigate fraudulent activities and present fraud reports to the relevant stakeholders
- Participate in the role of Auditing in line with Operations Auditing Practices.
- Review and assess regions, providers & other areas of risk to identify potential fraud or misrepresentation.
- Identify & report cost containment opportunities
- Identify areas of fraud risk & assist with the design & implementation of controls to mitigate that risk.
- Provide input into Operations Controls to achieve acceptable cost containment & fraud identification standards
- Create & facilitate Anti-Fraud Awareness & support material as required
- Liaise with Global Operations Functions to ensure consistency in the application of the Global Claims Fraud Framework
- Respond to client enquiries accurately and professionally and when necessary, liaise with additional departments to ensure an efficient response is given thereby achieving client satisfaction.
- Other Ad hoc duties as required
REQUIREMENTS
To be successful in this position you will need to have the following skills / experience:
Essential
- Bachelor’s degree in any Medical field, Paramedical, Finance, Business Administration, Insurance, or a related technical discipline is preferred.
- Minimum of 2 years of experience in a customer-focused environment, specifically within clinical/paramedical functions, a TPA, or the health insurance operations floor.
- Demonstrated experience analyzing and assessing high-value, highly complex medical claims portfolios for technical or clinical variances.
- Proficiency inside the MS Office suite (specifically advanced Excel for data tracking, Power BI for metric visualization dashboards, and PowerPoint for summary framing).
- Proven ability to work under pressure, manage time effectively, and meet tight deadlines and rigorous service standards.
- Hybrid working options are available as per business requirements and operational policy
- Valid work permit with the ability to work full time year round
Desirable
- Prior exposure to fraud detection concepts, medical billing systems (ICD-10, CPT, HCPCS), or claims risk frameworks.
- Prior experience dealing directly with healthcare providers and regulatory billing frameworks across the UAE or the wider GCC/Gulf region.
- Full professional fluency in English (written and spoken). Business-level Arabic or other regional languages is a distinct advantage
Personal Attributes
- Possesses a naturally investigative, curious personality that easily spots inconsistencies, unbundled billings, or patterns of over-utilization.
- Adheres strictly to facts, regulatory benchmarks, and objective data when evaluating disputed costs or flagging suspicious provider behavior.
- Operates with a helpful, peer-to-peer mindset, dedicated to transforming audit learnings into helpful coaching tools for the standard processing teams.
As an equal opportunity employer, Allianz Partners recognizes that our strength lies in our people and we are committed to diversity and inclusivity. So if you would like to be part of a global company that offers international career opportunities, kick-start your career and dare to join us!