Qureos Mentor

Sukoon Insurance

<div>
 
 
 About the Role:
 
 
 <ul>
 <li>
 We are seeking a highly skilled and experienced Fraud &amp; Risk Analyst to join our team. The ideal candidate will have proven experience in fraud risk management and possess a strong analytical mindset to identify and mitigate fraudulent activities.
 </li>
 <li>
 The role involves monitoring transactions, processes, and operational activities for fraud prevention purposes; detecting suspicious patterns, transactions, and behaviors through data analysis; and investigating potential fraud cases. The role contributes to financial loss mitigation, ensures regulatory compliance, and supports the protection of the company&rsquo;s reputation while maintaining a robust fraud risk governance framework.
 </li>
 <li>
 Excellent communication and presentation skills are essential for this role.
 </li>
 <li>
 This position reports to the Head of Risk.
 </li>
 </ul>
 
 
 
 
 
 Key Responsibilities:
 
 
 <ul>
 <li>
 Monitor and analyze transactions, processes, and operational activities to detect suspicious behavior and potential fraud.
 </li>
 <li>
 Identify, assess, and mitigate fraud risks using data-driven and analytical approaches.
 </li>
 <li>
 Support the development and implementation of fraud detection strategies, tools, and processes.
 </li>
 <li>
 Analyze data to identify anomalies, trends, and emerging fraud patterns.
 </li>
 <li>
 Conduct thorough investigations of suspected fraud cases and document findings.
 </li>
 <li>
 Escalate confirmed or high-risk fraud cases to relevant stakeholders in a timely manner.
 </li>
 <li>
 Collaborate with cross-functional teams to enhance fraud prevention measures and internal controls.
 </li>
 <li>
 Support the continuous improvement of fraud monitoring mechanisms and control frameworks.
 </li>
 <li>
 Prepare detailed reports and presentations on fraud trends, investigation outcomes, and key risk indicators.
 </li>
 <li>
 Communicate findings, insights, and recommendations clearly to management and stakeholders.
 </li>
 <li>
 Ensure adherence to applicable regulatory requirements, internal policies, and fraud risk frameworks.
 </li>
 <li>
 Assist in the preparation of regulatory reports and responses related to fraud incidents.
 </li>
 <li>
 Support internal and external audits, regulatory reviews, and compliance assessments.
 </li>
 <li>
 Stay updated on relevant regulations (e.g., DFSA/DIFC, AML/CTF) and incorporate requirements into fraud risk practices.
 </li>
 </ul>
 
 
 
 
 
 Team Collaboration:
 
 
 <ul>
 <li>
 Work closely with IT, Finance, Operations, and other departments to ensure effective fraud detection and prevention.
 </li>
 <li>
 Participate in regular team meetings to discuss ongoing cases and share insights.
 </li>
 <li>
 Provide training and guidance on fraud awareness and detection techniques.
 </li>
 <li>
 Foster a collaborative environment to continuously improve fraud prevention strategies.
 </li>
 </ul>
 
 
 
 
 
 Technical Skills:
 
 
 <ul>
 <li>
 Fraud analytics (predictive modelling, anomaly detection)
 </li>
 <li>
 Insurance domain knowledge (life, health, general insurance) preferred
 </li>
 <li>
 Investigation techniques and forensic analysis
 </li>
 <li>
 Risk assessment and control design
 </li>
 <li>
 Strong data handling and analytical tools (Excel, Power BI)
 </li>
 </ul>
 
 
 
 
 
 Soft Skills:
 
 
 <ul>
 <li>
 Strong analytical and problem-solving ability
 </li>
 <li>
 High ethical standards and integrity
 </li>
 <li>
 Attention to detail
 </li>
 <li>
 Stakeholder management and communication skills
 </li>
 <li>
 Ability to make sound decisions under uncertainty
 </li>
 </ul>
 
 
 
 
 
 Education &amp; Qualifications:
 
 
 <ul>
 <li>
 Bachelor&rsquo;s degree in Finance, Risk Management, Computer Science, or a related field
 </li>
 <li>
 Relevant certifications such as CFE, CAMS, or ICA (Financial Crime Compliance) are an advantage
 </li>
 </ul>
 
 
 
 
 
 Experience:
 
 
 <ul>
 <li>
 Minimum 5 years of experience in fraud detection and fraud risk management
 </li>
 <li>
 Exposure to claims and underwriting fraud preferred
 </li>
 <li>
 Experience with data analytics-driven fraud detection
 </li>
 </ul>
</div>

Fraud & Risk Analyst

<div>
 
 
 Job Summary:
 
 
 <ul>
 <li>
 Efficiently lead the Contact Centre&rsquo;s team to continuously improve Customer Service &amp; Production through consistent delivery of superior customer experience.
 </li>
 <li>
 Support the Contact Centre Head in ensuring adherence to Contact Center Service Standards / SOP&rsquo;s and Department Objectives.
 </li>
 </ul>
 
 
 
 
 
 Job Accountabilities:
 
 
 <ul>
 <li>
 Lead the call centre by developing, implementing and reviewing call centre processes for inbound and outbound operations and related responsibilities and tasks;
 </li>
 <li>
 Drive customer satisfaction by ensuring timely resolution of customer queries and complaints, building relations and gaining credibility, through continuous monitoring of call centre KPIS;
 </li>
 <li>
 Training &amp; Coaching: Maintaining high product knowledge level for all team members resulting is efficient call handling , sales and conversion ratio .
 </li>
 <li>
 Updating team members on Process changes, new product release &amp; system changes.
 </li>
 <li>
 Ensure consistency in adherence to the call centre guidelines, underwriting guidelines and operational procedures;
 </li>
 <li>
 Accountable for direct sales in the consumer lines of business;
 </li>
 <li>
 Ensure consistency in adherence to the call centre guidelines, underwriting guidelines and operational procedures;
 </li>
 <li>
 Quality Scores : Maintaining high call quality standards through daily guidance , buddy training &amp; calls monitoring.
 </li>
 <li>
 Set and measure performance targets for speed, efficiency, sales and quality;
 </li>
 <li>
 Manage the daily running of the call center, including sourcing equipment, effective resource planning and implementing call center strategies and operations;
 </li>
 <li>
 Set and measure performance targets for speed, efficiency, sales and quality;
 </li>
 <li>
 Monitor random calls to improve quality, minimize errors and track call center agent performance;
 </li>
 <li>
 Organize staffing, including shift patterns and the number of staff required to meet demand;
 </li>
 <li>
 Forecast and analyze data against budget figures on a weekly and/or monthly basis;
 </li>
 <li>
 Manage the complaint management function and ensure adherence to all DHA/HADD laws on complaint handling.
 </li>
 <li>
 Support team development through periodic review, mentoring, counseling, and feedback.
 </li>
 </ul>
 
 
 
 
 
 Key Performance Indicators (KPIs):
 
 
 <ul>
 <li>
 CC abandoned rate
 </li>
 <li>
 GPW production
 </li>
 <li>
 Team&rsquo;s Product knowledge
 </li>
 <li>
 GPW Production
 </li>
 <li>
 Team&rsquo;s Quality scores
 </li>
 <li>
 Service Excellency &amp; Complaint Management
 </li>
 <li>
 Team&rsquo;s Data Capture &amp; Accuracy
 </li>
 <li>
 MIS &amp; Reporting
 </li>
 <li>
 Initiative
 </li>
 </ul>
 
 
 
 
 
 Skills Required:
 
 
 <ul>
 <li>
 Proven experience as call center manager or similar position.
 </li>
 <li>
 Knowledge of performance evaluation and customer service metrics .
 </li>
 <li>
 Solid understanding of reporting and budgeting procedures.
 </li>
 <li>
 Experience in basic financial analysis (cost-effectiveness, cost-benefit etc.).
 </li>
 <li>
 Proficient in MS Office and call center equipment/software programs.
 </li>
 <li>
 Outstanding communication and interpersonal skills.
 </li>
 <li>
 Excellent organizational and leadership skills with a problem-solving ability.
 </li>
 <li>
 Positive and patient.
 </li>
 <li>
 Certified Call Center Manager (e.g. CCCM) or equivalent qualification is a plus.
 </li>
 </ul>
 
 
 
 
 
 Education, Experience and Formal/Professional Qualifications:
 
 
 <ul>
 <li>
 Graduate of any bachelor&rsquo;s degree
 </li>
 <li>
 5 years experience in Insurance / Finance industry
 </li>
 <li>
 5 years experience in Call Center /Customer service team lead role
 </li>
 </ul>
 
 
</div>

Manager, Call Center

<div>
 
 Medical Pre-authorization Team is looking for a dedicated DRG Inpatient Pre-authorization Specialist to join us in strengthening our approvals and drive case management.
 
 
 
 
 
 Job Purpose:
 
 <ul>
 <li>
 The jobholder will be responsible for managing inpatient cases as per defined TAT and ensuring accuracy of DRG codes submitted by Healthcare Providers.
 </li>
 <li>
 Jobholder must possess ability to deliver in a metric driven high pressure environment which functions in real time.
 </li>
 <li>
 Strong attention to detail; high degree of speed and adjudication accuracy.
 </li>
 <li>
 Strong proficiency in handling computer and software skills.
 </li>
 </ul>
 
 
 
 
 Job Responsibilities:
 
 <ul>
 <li>
 Visit providers to manage inpatient cases, review DRG codes/severity levels submitted by healthcare facilities.
 </li>
 <li>
 Coordinate with physicians/providers efficiently&amp; Ensure effective communication with provider.
 </li>
 <li>
 Negotiate cost with providers, ensure correct length of stay of inpatient cases and effective implementation of insurance protocol/DRG billing.
 </li>
 <li>
 Ensure all regulatory guidelines issued by the various regulatory bodies are adhered within day to day operations.
 </li>
 <li>
 Meet DRG Case Management defined targets;
 </li>
 <li>
 Meet 100% of assigned onsite visits to identify medical negligence, compromised member care and wastage . 100% compliance of ePAR process and guidelines.
 </li>
 <li>
 Ensure closure of case visit findings and accurate adjudication of ePAR cases.
 </li>
 <li>
 Prepare analytical reports of DRG cases and billing on a monthly basis.
 </li>
 </ul>
 
 
 
 
 Additional Skills:
 
 <ul>
 <li>
 Excellent coding skills; minimum five years of coding and IR-DRG and AP DRG experience.
 </li>
 <li>
 Knowledge of MS Office especially in MS-Excel.
 </li>
 <li>
 Knowledge of the full know-how of UAE insurance industry and regulatory environment. Interpersonal and influencing skills. Problem solving and decision making capabilities.
 </li>
 <li>
 Good command over English (Written, Spoken &amp; Reading).
 </li>
 <li>
 Any Certifications in Medical Coding will be a key advantage.
 </li>
 <li>
 Ability to work under pressure and multitask in a highly dynamic environment.
 </li>
 <li>
 Good communication, negotiation, presentation and interpersonal skills.
 </li>
 </ul>
 
 
 
 
 Qualifications:
 
 <ul>
 <li>
 Bachelor&rsquo;s degree in medicine is mandatory.
 </li>
 <li>
 Globally recognized qualification in coding skill. Insurance qualification/background is essential in similar role.
 </li>
 <li>
 Minimum working experience of 1-2 years in UAE in similar role.
 </li>
 <li>
 Candidate must have good exposure to IP case preapproval protocols.
 </li>
 <li>
 Candidate must possess and be well versed with regulatory guidelines.
 </li>
 </ul>
</div>

Specialist,DRG Case Management

Join Sukoon Insurance and explore 3   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.

Sukoon Insurance

About Company

Fraud & Risk Analyst

Manager, Call Center

Specialist,DRG Case Management