Internal Audit Governance

3 days ago

Cochin, Kerala, India AImploy Full time

Internal Audit & Governance

A UAE Medical TPA Internal Audit and Governance Officer ensures the organization's internal controls, risk management, and governance processes are effective and compliant with regulations. Key responsibilities include planning and executing audits of claims management and other operations, evaluating risks, ensuring compliance with medical coding standards, and reporting findings and recommendations for improvement to management. The role requires strong analytical skills, knowledge of healthcare regulations in the UAE, and experience with internal audit methodologies.

Core responsibilities


• 
Conduct internal audits:
 Plan and execute independent audits to assess the effectiveness of internal controls, risk management, and governance processes.


• 
Ensure compliance:
 Verify adherence to medical coding standards (such as DHA/HAAD/MOH), clinical governance standards, and other relevant regulatory requirements.


• 
Risk assessment:
 Identify and evaluate the effectiveness of the TPA's risk management framework and controls.


• 
Claims process review:
 Analyze and audit the claims management process for efficiency, accuracy, and fraud prevention.


• 
Data analysis:
 Use data analysis and computerized audit tools to identify trends, anomalies, and areas for improvement.


• 
Reporting and recommendations:
 Document audit findings, develop conclusions, and present audit results and recommendations to management and process owners.


• 
Issue remediation:
 Track and follow up on the implementation of audit recommendations to ensure timely closure of issues.


• 
External audit support:
 Assist with external audits by coordinating with external auditors and providing necessary documentation.


• 
Governance support:
 Contribute to the development and implementation of data governance strategies to improve data quality and reporting accuracy.

Required skills and qualifications


• 
Bachelor's degree in accounting, finance, or a related field is often required.


• 
Relevant professional certifications such as CIA (Certified Internal Auditor) or CPA (Certified Public Accountant) are desireable..


• 
Strong knowledge of internal audit principles, risk management frameworks, and internal control standards.


• 
Experience in healthcare, insurance, or a Third Party Administrator (TPA) environment is highly desirable.


• 
Thorough understanding of medical coding (e.g., CPT, ICD-10) and billing practices is often required, especially for roles with a clinical audit focus.


• 
Excellent analytical, problem-solving, and communication skills.


• 
Familiarity with UAE healthcare regulations is crucial.


• 
Experience with data analysis and computerized audit tools is a plus. 

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