Medical Quality & Audit Officer (Dentist)

Job description

Company Description
QLM Life and Medical Insurance is the largest health insurance provider in the State of Qatar, offering specialized services tailored to meet the diverse needs of the community. The company leads the health insurance sector with innovative and flexible insurance programs designed to suit individuals and organizations. QLM is recognized for its commitment to excellence and superior customer service. It provides advanced solutions to ensure comprehensive coverage and support for its members.

Role Dimensions

The successful candidate will be responsible for conducting provider audits, reviewing medical claims, identifying billing discrepancies, and ensuring compliance with insurance policies and regulatory requirements. This role also supports audit reporting and provides guidance to junior team members.

Key Responsibilities

• Conduct provider field audits and clinical documentation reviews.
• Review medical claims and pre-approvals for coding accuracy, medical necessity, and policy compliance.
• Identify billing irregularities, fraud, waste, and abuse (FWA) indicators.
• Prepare audit reports, document findings, and communicate with healthcare providers.
• Manage audit cases from initiation through completion.
• Support recovery, reconciliation, and quality improvement initiatives.
• Guide and support Senior Associates during audit activities.
• Ensure compliance with internal policies, audit standards, and regulatory requirements.

Requirements

• Bachelor's degree in Dentistry.
• 3–5 years of experience in health insurance, medical audit, clinical review, or claims management.
• Strong knowledge of ICD-10, CPT, and DRG coding.
• Experience in provider audits, medical claims review, and healthcare documentation.
• Good analytical, investigative, and report-writing skills.
• Proficiency in Microsoft Office and healthcare claims/EMR systems.
• Willingness to travel for provider field audits within Qatar.

If you have a strong clinical background, audit experience, and are passionate about improving healthcare quality, we encourage you to apply.

Pay: QAR1.00 - QAR2.00 per month

Work Location: In person