Medical Quality Specialist

Job Overview:

The Medical Quality Specialist the implementation and maintenance of quality assurance systems and procedures. This role ensures that processes meet internal and external quality standards, regulatory requirements, and customer expectations. The position involves leading internal audits, analyzing data, coordinating with cross-functional teams, and driving continuous improvement initiatives.

Main Task, Duties, Responsibilities & Accountabilities

Quality Assurance & Compliance

· Monitor and evaluate the quality of claims processing, customer service, and other operational functions.

· Ensure compliance with healthcare regulations such as DHA, MOH, and international standards like ISO 9001.

· Conduct internal audits and support external audits by regulatory bodies or clients.

· Implement Corrective and Preventive Actions (CAPA) for identified non-conformities.

Process Improvement

· Identify gaps in operational workflows and recommend improvements.

· Lead or support Six Sigma or Lean initiatives to enhance efficiency and reduce errors.

· Develop and update SOPs (Standard Operating Procedures) to reflect best practices.

Data Analysis & Reporting

· Analyze quality metrics

· Prepare dashboards and reports for senior management to track performance trends.

· Collaborate with Operations teams to resolve root causes of defects and implement preventive measures

Stakeholder Coordination & Customer Experience Management

· Liaise with internal departments (claims, customer service, IT) to ensure quality alignment.

· Investigate complaints and ensure timely resolution with a focus on service recovery.

Preferred Qualification, Experience & Skills

· Bachelor's degree in healthcare management, quality management, or a related field.

Advanced degrees or certifications like ISO 9001, Six Sigma, or Lean are a plus.

Experience:

· +5 years of experience in claims review, quality assurance, or compliance auditing.

· Familiarity with healthcare regulations in the UAE or GCC.

Experience with regulatory standards (e.g., DHA, HAAD, MOH, or international standards like ISO 9001).

Job Type: Full-time

Work Location: In person