Hiring for an Reputed Insurance Company based at Muscat, Oman.
Job Title: Supervisor – Claims Audit & Risk (Medical Insurance)
Job Purpose
We 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 Responsibilities
Perform detailed audits of inpatient and outpatient medical claims Identify irregularities, billing discrepancies,



and potential abuse patterns Support investigations into suspicious claims and document findings Conduct retrospective reviews and assist in recovery of overpayments Apply clinical knowledge to evaluate treatment appropriateness and medical necessity Collaborate with providers and internal teams for claims validation and control measures Analyze claims data to identify trends and improvement opportunities Support development of reports and dashboards for audit tracking and savings Assist in provider reviews and highlight non-compliance or risk indicators Contribute to process improvements, SOPs, and audit frameworks Qualifications
MD / MBBS (or equivalent medical degree) Experience in medical insurance, TPA, or healthcare audit environments Exposure to fraud detection / claims investigation is an added advantage Experience
4–8 years in claims auditing / utilization review / medical insurance Experience working with TPAs or insurance companies preferred Key Skills
Strong clinical and medical claims assessment skills Good understanding of healthcare billing and coding practices Analytical mindset with basic data handling (Excel) Robust documentation and reporting skills Ability to work in a structured, process-driven env

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