Qureos Mentor

Dubai Insurance TPA

1. JOB PURPOSEThe Clinical Guidelines Executive is responsible for developing, implementing, and maintaining clinical guidelines based on international treatment standards, customized to align with Nas Neuron's payer and internal policies. The role supports the Utilization Review &amp; Management team by creating guidelines that ensure all medical services provided to members are clinically appropriate, cost-effective, and consistent with high-quality care standards.2. RESPONSIBILITIES AND DUTIESKey Responsibilities:1. Guideline Development: Research and compile clinical guidelines using international treatment standards and evidence-based practices, customizing them to meet the specific requirements of Nas Neuron's payer and internal policies.2. Policy Alignment: Ensure clinical guidelines align with insurance coverage criteria, establishing clear criteria for medical necessity and service appropriateness.3. Documentation and Repository Maintenance: Develop and maintain a centralized repository of clinical guidelines and ensure they are readily accessible to stakeholders within the organization.4. Cross-functional Collaboration: Collaborate with Medical Operations, Coding, and Claims Review teams to ensure guidelines are effectively implemented and understood across departments.5. Continuous Update and Training: Stay current with updates in international treatment standards, continuously update guidelines, and provide necessary training to team members on guideline changes.3. KNOWLEDGE, SKILLS AND EXPERIENCEEducation: Bachelor&rsquo;s degree in medicine, Nursing, Health Administration, or a related clinical field.Skills and Competencies:Technical and Analytical Skills<ul><li>Clinical Knowledge: Strong understanding of international treatment guidelines and evidence-based standards (e.g., NICE, AHRQ, WHO) to create guidelines that are relevant to the healthcare insurance context.</li><li>Medical Coding Proficiency: Familiarity with medical coding (ICD-10, CPT) the tools available for coding and the ability to apply coding guidelines in line with clinical protocols and insurance requirements.</li><li>Analytical Skills: Strong analytical skills to research, interpret, and adapt international clinical guidelines into practical, customized guidelines for insurance coverage policies.</li></ul>Communication and Documentation<ul><li>Clear Documentation Skills: Ability to compile, organize, and document clinical guidelines into a well-maintained and easily accessible repository.</li><li>Effective Communication: Excellent verbal and written communication skills, with the ability to clearly convey complex clinical guidelines to internal teams, including non-clinical stakeholders.</li></ul>Collaboration and Interpersonal Skills<ul><li>Cross-functional Collaboration: Strong interpersonal skills to work effectively with Medical Operations, Coding, and Claims Review teams, ensuring smooth implementation and understanding of guidelines.</li><li>Stakeholder Engagement: Ability to support team members and communicate updates on clinical guidelines, addressing inquiries or challenges in the application of guidelines.</li></ul>Continuous Learning and Adaptability<ul><li>Adaptability to Regulatory and Industry Changes: Ability to stay current with updates to international guidelines, healthcare regulations, and insurance industry standards, making timely revisions to ensure guidelines remain relevant.</li><li>Detail-oriented Approach: Keen attention to detail to ensure all guidelines are accurate, thorough, and compliant with insurance coverage criteria.</li></ul>Problem-solving and Improvement Mindset<ul><li>Problem-solving Abilities: Capability to identify gaps or issues in existing guidelines and proactively recommend adjustments or improvements to maintain efficiency and accuracy.</li><li>Commitment to Continuous Improvement: Motivation to stay updated with emerging evidence-based practices and integrate improvements that support the organization&rsquo;s standards of care and operational goals.</li></ul>&middot; Ethical and professional: High standards of integrity and compliance, with a commitment to delivering the best possible care to members.Key Attributes1. Detail-Oriented<ul><li>Meticulousness: Ability to thoroughly review clinical guidelines, ensuring accuracy and alignment with evidence-based practices and regulatory standards.</li><li>Precision: Focus on detail when drafting and maintaining guidelines to avoid ambiguity and ensure clarity for healthcare providers.</li></ul>2. Analytical Thinker<ul><li>Critical Analysis: Skill in evaluating clinical evidence, treatment protocols, and guidelines to ensure they are relevant and effective.</li><li>Problem-Solving Orientation: Capability to identify gaps in existing guidelines and recommend improvements based on data and feedback.</li></ul>3. Collaborative<ul><li>Interpersonal Skills: Strong ability to work with multidisciplinary teams, including medical committees, healthcare professionals, and internal stakeholders.</li><li>Team Player: Willingness to engage with others to refine guidelines and ensure they meet the needs of both patients and providers.</li></ul>4. Ethical and Professional<ul><li>Integrity: Commitment to maintaining high ethical standards in the development and dissemination of clinical guidelines.</li><li>Professionalism: Approaches all tasks with a high degree of professionalism, respecting confidentiality and compliance with regulations.</li></ul>5. Strategic Mindset<ul><li>Long-Term Vision: Ability to see beyond immediate tasks and understand the broader implications of guidelines on healthcare delivery and outcomes.</li><li>Proactive Approach: Takes initiative to address emerging clinical issues or changes in medical practice that may require updates to guidelines.</li></ul>6. Effective Communicator<ul><li>Clear Communication: Ability to convey complex clinical information and guidelines in a manner that is easily understood by healthcare providers and non-clinical stakeholders.</li><li>Educational Skills: Proficient in educating healthcare teams about new guidelines and protocols, facilitating understanding and compliance.</li></ul>7. Research-Oriented<ul><li>Commitment to Evidence-Based Practice: Passion for staying updated on the latest clinical research, treatment modalities, and best practices.</li><li>Curiosity: A desire to explore new developments in healthcare that could inform guideline updates and improvements.</li></ul>8. Adaptable<ul><li>Flexibility: Ability to adjust guidelines based on evolving clinical evidence, regulatory requirements, and organizational needs.</li><li>Resilience: Maintains focus and effectiveness in a fast-paced healthcare environment, especially when faced with complex clinical challenges.</li></ul>Work Experience: 2-3 years of experience in clinical guideline development, utilization review, or clinical operations within healthcare or insurance.Job Type: Full-timePay: AED8,000.00 - AED10,000.00 per monthEducation:<ul><li>Bachelor's (Preferred)</li></ul>Experience:<ul><li>Insurance: 3 years (Preferred)</li><li>Coding: 2 years (Preferred)</li></ul>

Clinical Guidelines Analyst - With CPC and Insurance/Healthcare experience

&middot; A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company.&middot; Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information.&middot; In addition, a processor must keep meticulous records of claims and follow up on lapsed cases.&middot; Medical claims processors are expected to have an extensive knowledge of medical terminology, as well as experience using a computer.<ul><li>Recording and maintaining insurance policy and claims information in a database system.</li><li>Determining policy coverage and calculating claim amounts.</li><li>Processing claims payments.</li><li>Answering queries related to Policy coverage criteria and guidelines.</li><li>Complying with federal, state, and company regulations and policies.</li></ul>&middot; Since medical claims processors must approve or deny payment to doctors, it is vital that they know how to correctly read and assess medical documents.&middot; Good communication skills are necessary to converse with doctors' offices or insurance companies if there is a problem with the claim.<ul><li>Performing other clerical tasks, as required.</li></ul>Job Types: Full-time, PermanentPay: AED6,000.00 - AED7,000.00 per monthAbility to commute/relocate:<ul><li>Dubai: Reliably commute or planning to relocate before starting work (Required)</li></ul>Education:<ul><li>Bachelor's (Preferred)</li></ul>Experience:<ul><li>claim&rsquo;s processor or in a related role.: 2 years (Preferred)</li></ul>

Nurse Claims Officer - Insurance TPA

1. JOB PURPOSEAs a Data Analyst, you will be responsible for delivering analytics solutions and reporting capabilities that meet the needs of NAS Neuron. This will span across multiple domains, including Fraud, Waste, Abuse, Utilization management and Operations. Robust analytics solutions will help drive growth through meaningful insights and ensure NAS Neuron continues to evolve and deliver world class experiences and solutions to our customers and partners.How?&sect; Continually provide analytic and business insights to address stakeholder gaps and/or opportunities, and to create value&sect; Proactively identify data-driven issues and opportunities, and use the appropriate level analytic support to drive solutions&sect; Design and implement analytics solutions that are scalable and can be used in the most efficient way by the end user&sect; Ensure NAS Neuron continues to innovate and delivers solutions that meets the needs of internal users, our customers, and our partners2. RESPONSIBILITIES AND DUTIES&sect; Understand and identify all data sources relevant to the NAS Neuron business&sect; Support data governance and management strategy to ensure quality of reporting and analytics.&sect; Facilitate data stewardship to ensure data is consistent, accurate and accessible.&sect; Identify opportunities to leverage better tools to enhance our efficiency &amp; proficiency in reporting.&sect; Proactively engage with functional teams, as well as global counterparts to understand best practices, to design and execute analytics solutions for our business.&sect; Enable data-visualization, analysis, and prototyping in service of the markets' immediate needs.&sect; Provide input to inform reporting solution design to deliver automated dashboard capabilities.&sect; Embed analytics within our day-to-day business practices and decision-making, as well as into our culture and mind-set.3. KNOWLEDGE, SKILLS AND EXPERIENCE&sect; 2- 4+ years of experience in Healthcare analytics capacity driving business outcomes using data and analytics&sect; 2-4+ years&rsquo; analytics experience in a TPA or a Health Insurance Company&sect; Strong analytical capabilities and experience in building business intelligence solutions&sect; Math, Computer science or related technical background + willingness to dive into technology&sect; Strong foundational skills with analytics software such as Tableau, PowerBI, Qliksense, SQL, Python &amp;/or R&sect; Good understanding of Machine Learning frameworks with hands on experience in implementing at least one end to end use case&sect; Experience in a complex, fast-paced, quantitative environment with a high bar for attention to detail and quality of work&sect; Excellent verbal and written executive communication skills and corporate agility&sect; Fast learner and takes initiative&sect; Strong passion for changing healthcare&sect; Above all, you are self-sufficient, intellectually curious and take ownership for everything you doJob Type: Full-timePay: AED12,000.00 - AED15,000.00 per monthExperience:<ul><li>Insurance: 2 years (Required)</li></ul>

Data Analyst - with Insurance/TPA experience

The AI Product Manager will lead the development and rollout of intelligent, scalable AI solutions that drive business efficiency and healthcare innovation. This role bridges strategy and execution; translating business needs into AI-powered tools that deliver measurable impact. It&rsquo;s a cross-functional leadership position that requires strong technical fluency, stakeholder alignment, and a clear vision for how AI can transform operations across departments.RESPONSIBILITIES AND DUTIES<ul><li>Own the full lifecycle of AI products&mdash;from ideation, prototyping, and development to launch, iteration, and continuous improvement.</li><li>Define and communicate the product vision, strategy, and roadmap for AI-driven solutions aligned with the company goals.</li><li>Identify and prioritize high-impact AI use cases across functions (Sales, Operations, Customer Care, Marketing, Finance, HR, Support, etc) to drive innovation and operational efficiency.</li><li>Lead the establishment of Agile processes for AI product development, including backlog prioritization and sprint planning, to ensure structured and timely delivery of AI initiatives.</li><li>Collaborate cross-functionally with engineering, design, data science, ML engineers, and marketing teams to build, deploy, and scale AI models and products.</li><li>Develop and maintain clear product requirements, success metrics (e.g., model accuracy, business KPIs), and performance monitoring frameworks.</li><li>Conduct market research, competitor analysis, monitor industry trends and R&amp;D on cutting-edge AI technologies, especially Generative AI and Large Language Models, to inform product decisions and maintain competitive advantage.</li><li>Manage AI model testing, validation, and lifecycle, ensuring models meet performance, ethical, and compliance standards.</li><li>Prepare business cases, presentations, and regular updates for senior leadership to secure approvals and align stakeholders.</li><li>Drive adoption through training, vendor management, and ensuring data quality, security, and ethical AI use across the organization.</li></ul>CANDIDATE PROFILE/EVALUATION CRITERIA <ul><li>Bachelor&rsquo;s degree in business, Engineering, Computer Science, or a related field. Advanced degrees or certifications in AI/ML are a plus from recognized institutes</li><li>Minimum 5 years of product management experience in a technology-driven environment, preferably with exposure to AI, machine learning, or data science projects.</li><li>Strong understanding of the insurance or health services industry is an advantage.</li><li>Proven track record of managing AI or software products through their full lifecycle&mdash;from ideation to launch and iteration.</li><li>Exceptional analytical and problem-solving skills with the ability to interpret complex data and make data-driven decisions.</li><li>Excellent verbal and written communication skills, capable of engaging and aligning stakeholders at all organizational levels.</li><li>Strong business acumen with the capability to translate strategic business needs into innovative AI product solutions.</li><li>Demonstrated leadership skills, including the ability to influence cross-functional teams and manage vendor relationships.</li><li>Knowledge of data privacy, compliance, and ethical considerations related to AI implementation.</li></ul>CORE ATTRIBUTES<ul><li>Strategic Thinker: Able to translate business goals into AI product strategies that deliver measurable impact.</li><li>Cross-Functional Leader: Comfortable working across departments&mdash;engineering, data science, marketing, operations, and executive leadership.</li><li>AI-Fluent: Understands AI/ML concepts deeply enough to guide development, evaluate models, and communicate trade-offs.</li></ul>TECHNICAL COMPETENCIES<ul><li>Must have built end to end workflow using AL models.</li><li>AI/ML Fundamentals: Familiarity with supervised/unsupervised learning, NLP, generative AI, and model lifecycle.</li><li>Prompt Engineering &amp; LLMs: Experience crafting prompts and working with models like GPT, Claude, Gemini.</li><li>RAG Systems: Understanding of Retrieval-Augmented Generation and how to integrate external knowledge sources.</li><li>Tool/Function Calling: Ability to design JSON schemas, manage retries, and ensure system reliability.</li><li>Model Evaluation: Skilled in comparing models (accuracy, precision, recall), tracking hallucinations, and designing golden sets or A/B tests.</li><li>Data Governance: responsible for adherence of data governance. Awareness of privacy, masking, redaction, and compliance standards.</li></ul>RELEVANT TECHNOLOGIES <ul><li>Familiarity with AI and machine learning concepts, including supervised and unsupervised learning, model training, evaluation, and deployment.</li><li>Familiarity with AI technologies and tools (e.g., Generative AI, Large Language Models, OpenAI, LangChain, Zapier) is beneficial.</li><li>Experience working with AI frameworks and platforms such as TensorFlow, PyTorch, or scikit-learn is a plus.</li><li>Knowledge of data preparation, feature engineering, and data quality management to support AI model development.</li><li>Hands-on experience or strong understanding of AI integration with software development processes and APIs.</li><li>Familiarity with Agile project management tools such as Jira, Trello, or Azure DevOps.</li><li>Basic understanding of cloud platforms and services (AWS, Azure, Google Cloud) related to AI/ML deployment and scalability.</li><li>Knowledge of data privacy, security, and compliance standards in AI applications.</li><li>Comfortable interpreting technical reports and communicating AI model performance metrics (accuracy, precision, recall, etc.) to non-technical stakeholders.</li></ul>Job Type: Full-timePay: AED40,000.00 - AED50,000.00 per month

Artificial Intelligence Product Manager

The Nurse Case Manager will assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual&rsquo;s health needs. Assistance may include such activities as providing clinical information regarding medical conditions or treatments, identifying providers and coordinating complex care plans. The Nurse Case Manager will promote quality cost-effective outcomes managing care needs through education and health advocacy to members serviced. The Nurse Case manager isable to work independently and effectively communicate to internal and external customers by telephone, email or face to face with customers.1. MAJOR RESPONSIBILITIES AND DESIRED RESULTSUses clinical knowledge to assess diagnosis and treatment plans and goals, and identifies gaps in care or risks for readmission or complications.<ul><li>Manages/coordinates an active volume of cases by providing information, navigation and coordination to customers worldwide.</li><li>Works with a multicultural population and is constantly aware of the cultural differences among that population.</li><li>Establishes patient centric goals and interventions to meet the member&rsquo;s needs</li><li>Interfaces with the member, family members/caregivers, and the healthcare team, as well as internal matrix partners.</li><li>Balances business needs with patient advocacy</li><li>Assesses member&rsquo;s health status and treatment plan and identifies any gaps or barriers to healthcare.</li><li>Visit providers to manage and coordinate care for customers by reviewing medical and claim information, ensure compliance with approved services and fees and discuss cases with hospital staff and physicians.</li><li>Establishes a documented patient centric case management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.</li><li>Work with physicians to evaluate complex cases and receive appropriate clinical expertise on diagnosis and treatment plans</li><li>Responsible for delivering to customers clinical programs including case management, chronic condition management, lifestyle coaching, pre assignment assessment and any other program delivered by global clinical operations.</li><li>Coordinate care with other nurses from other regions around the world when a need for local or regional expertise is important for better care or to comply with regulations</li><li>Maintains accurate workflow and process documents</li><li>Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures</li><li>Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.</li><li>Demonstrates sensitivity to culturally diverse situations, clients and customers.</li><li>Serve as clinical liaison to Clients</li><li>Other duties as assigned</li></ul>Job Type: Full-timePay: AED10,000.00 - AED15,000.00 per monthEducation:<ul><li>Bachelor's (Preferred)</li></ul>Experience:<ul><li>hospital: 3 years (Preferred)</li><li>Insurance: 3 years (Preferred)</li><li>TPA: 3 years (Preferred)</li><li>Case Management: 3 years (Preferred)</li></ul>Language:<ul><li>English (Preferred)</li></ul>

Nurse - Case Manager Clinical - TPA - Insurance (Arabic/German/French speakers)

RESPONSIBILITIES AND DUTIESResearch and follow up on Medical Treatment patterns and conduct utilization reviews for Beneficiaries (Policyholders) &amp; Medical Network providers, Quality control by:&sect; Being available (On call) 24 hours a day for Claim Centre Officers queries relating to in-patient claims.&sect; Assess day-care and in-patient cases as per medical justification and policy coverage.&sect; Issuing day-care and in-patient cases within AED 15,000.00 for medically justified cases in line with the policy.&sect; Escalate and confirm grey-area cases. Confirming of exclusions of borderline cases OP/IP.&sect; Assists CC officers and supervisors in claims adjudication cases as needed.&sect; Sending request of confirmation and notification to corresponding payers as needed.&sect; Responding to payer's queries in relation to day-care and In-patient cases.&sect; Responding to the payers request for advice on coverage of cases.&sect; Monitor Claims cost as per internal guidelines.&sect; Rejecting medically unjustified and policy wise excluded day-care and in-patient cases to be signed by Chief Medical Officer.&sect; Conformity of assessment for the prescribed tests/medications/investigations/clinical procedures&sect; Issuing day-care and In-patient cases Reimbursement Approval in line with medical and policy coverage.&sect; Contacting provider for queries and clarifications.&sect; Doing clinical discussion directly with the network's doctor as needed.&sect; Seeking verbal clinical opinion from Network's doctor as needed.&sect; Document and report to CC Supervisor, Assistant Manager and Manager any suspected fraud cases.&sect; Monitoring and maintaining the claims processing and adjudicating cycle in operational software system as per the defined terms and policy of the organization.&sect; Establishing strategies and implementing effective parameters for solving all possible queries within the team.&sect; Taking a lead role in assuring that the assigned tasks to the team are completed within the allocated time frame.&sect; Ensures the proper communication and implementation of new formats, training and processing rules.&sect; Entering and processing/ adjudicating claims in operational software system as per the terms and policy of the organization.&sect; Taking initiatives to maximize team efficiency.&sect; Maintaining both qualitative and quantitative claims measures.&sect; Achieving required processing targets assigned by the team-leader on daily, weekly and monthly basis.&sect; Monitor the qualitative and quantitative measures for IP-claims &amp; pre-approvals.&sect; Ensure compliance to any changes in terms of system parameters or process.&sect; Assisting the CC Supervisors / Asst. Manager and Managers as needed.&sect; Any additional duties commensurate with your position as may be assigned to you from time to time by the Company.3. KNOWLEDGE, SKILLS AND EXPERIENCE&sect; Medical Doctor (MBBS degree/ MD degree)&sect; 2 - 3 years&rsquo; experience in the healthcare industry/hospitals is mandatory&sect; Basic Industry knowledge (healthcare/insurance) is a plus.&sect; Should be a team-player with an aptitude for customer service&sect; Must be service oriented&sect; Highly decisive with outstanding logic and reasoning skills&sect; Excellent oral and written communication skills&sect; Must be computer literate&sect; Excellent command of the English language, Arabic is a plus&sect; Candidate must be tactful and discrete when dealing with clients and must be able to handle confidential information&sect; Ability to work under pressure and meet tight deadlines and varying work-schedulesJob Types: Full-time, PermanentPay: AED9,000.00 - AED10,000.00 per monthEducation:<ul><li>Bachelor's (Preferred)</li></ul>Experience:<ul><li>Hospital: 2 years (Preferred)</li><li>Medical Insurance: 1 year (Preferred)</li></ul>

Medical Officer - (MBBS) with insurance TPA experience

Join Dubai Insurance TPA and explore 6   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.