Job Title

Hiring for an Reputed Insurance Company based at Muscat, Oman.Job Title: Supervisor – Claims Audit & Risk (Medical Insurance)Job PurposeWe are seeking a medically qualified professional to support Quality Assurance within the medical insurance function, focusing on claims auditing, utilization review, and risk identification with exposure to fraud detection. The role is ideal for candidates with strong clinical and insurance experience looking to expand into fraud and audit leadership.Experience in utilization review, pre-authorization, medical claims auditing, and exposure to fraud detection and abuse patterns…Key ResponsibilitiesPerform detailed audits of inpatient and outpatient medical claimsIdentify irregularities, billing discrepancies, and potential abuse patternsSupport investigations into suspicious claims and document findingsConduct retrospective reviews and assist in recovery of overpaymentsApply clinical knowledge to evaluate treatment appropriateness and medical necessityCollaborate with providers and internal teams for claims validation and control measuresAnalyze claims data to identify trends and improvement opportunitiesSupport development of reports and dashboards for audit tracking and savingsAssist in provider reviews and highlight non-compliance or risk indicatorsContribute to process improvements, SOPs, and audit frameworksQualificationsMD / MBBS (or equivalent medical degree)Experience in medical insurance, TPA, or healthcare audit environmentsExposure to fraud detection / claims investigation is an added advantageExperience4–8 years in claims auditing / utilization review / medical insuranceExperience working with TPAs or insurance companies preferredKey SkillsStrong clinical and medical claims assessment skillsGood understanding of healthcare billing and coding practicesAnalytical mindset with basic data handling (Excel)Strong documentation and reporting skillsAbility to work in a structured, process-driven environmentKey Skills: Medical Claims AuditingUtilization Review / Medical Necessity AssessmentHealth Insurance / TPA OperationsFraud Detection & Abuse IdentificationClinical Decision-Making (MBBS/MD)Claims Adjudication & Pre-AuthorizationHealthcare Billing & Coding Knowledge (ICD/CPT)Data Analysis & Reporting (MS Excel)Risk Assessment & Cost ContainmentStakeholder Management (Providers & Internal Teams)