Automation & Claims Engine-Lead 1

JOB OVERVIEW

The Automation Claims Engine Lead is responsible for driving the strategic automation agenda within Health Operations, with a focus on enhancing zero touch, rules based claims adjudication and strengthening governance frameworks that enable scalable process transformation, ensuring operational readiness for emerging AI driven adjudication models.

The role requires strong technical expertise, cross functional coordination, and the ability to translate business needs into scalable automation solutions that improve efficiency, accuracy, and compliance across claims and approvals.

KEY RESPONSIBILITIES
Responsibilities will include, but are not limited to, the following:

Automation Strategy & Leadership
•     Lead the development and execution of the automation roadmap across Health Operations.
•     Drive improvements in ZTP %, manual review reduction, TAT, and cost per transaction.
•     Ensure automation initiatives align with business KPIs, regulatory requirements, and operational priorities.
•     Foster a culture of continuous improvement and digital enablement within the team.

Rules Engine & System Controls
•    Oversee the design, maintenance, and optimization of rules and logics within the Claims Adjudication Rules Engine.
•    Ensure accurate implementation of medical controls, edits, and compliance driven rules.
•    Conduct regular system audits, UAT cycles, and validation checks to maintain adjudication accuracy and reliability with focus on creating FWA checks.
•    Collaborate with IT and Digital teams on AI based adjudication enhancements and system upgrades.

  Operational Excellence
•    Lead process re engineering efforts to streamline workflows prior to automation deployment.
•    Maintain updated documentation, SOPs, and governance frameworks for automated processes.
•    Monitor automation performance and provide insights to senior management

 Stakeholder Management
•     Act as a key point of contact for Operations, IT, Digital, Quality, and Policy Management teams.
•     Provide clear and timely feedback on system behaviour, rule outcomes, and operational impacts.
•     Support communication of automation updates, rule changes, and system enhancements to internal and    external stakeholders.
•     Assist in explaining declined claims and system driven decisions to clients when required.

Training & Knowledge Transfer
•    Train operations teams on rules, edits, system controls, and automation logic.
•    Support onboarding and upskilling of new team members on automation processes.
•    Promote cross functional understanding of automation capabilities and limitations.

Reporting & Governance
•    Track and report key automation KPIs, including STP performance, error rates, and rule effectiveness.
•    Ensure compliance with internal policies and external regulatory requirements (DHA, DOH etc where applicable).
•    Provide structured insights, dashboards, and recommendations to senior leadership.
•    Support audit activities and contribute to medical governance committees as required.

REQUIREMENTS
To be successful in this position you will need to have the following skills / experience:

Essential
•    Medical degree with hands on experience in the UAE health insurance sector.
•    Strong clinical guideline knowledge and expertise in UAE and regional regulatory frameworks.
•    Certified medical coder with practical experience across multiple coding standards, including ICD 10 CM, ICD 10 AM, CPT, HCPCS, ACHI, CDT, and DRG classification.
•     Advanced data analytical skills with proficiency in Excel, Word, and PowerPoint.
•    Demonstrated experience working within automation driven or rules based adjudication environments.
•    Strong understanding of claims operations, medical controls, and Revenue Cycle Management.

Desirable
•     Certification in AI in Healthcare or data analytics, demonstrating readiness for future AI enabled operating models.
•     Exposure to RPA, rules engines, or AI assisted adjudication tools

Personal Attributes
•    Results driven and pragmatic, focused on achieving measurable outcomes.
•    Confident communicator and facilitator, able to build trust across diverse stakeholder groups.
•    Collaborative and resilient, thriving in a dynamic and fast moving environment.

How We Hire

Agency Statement Allianz Partners does not accept unsolicited CV’s or approaches from agencies. We only work with partners on our approved supplier list, under contract. Any unsolicited submission will not be considered.

What We Offer

Allianz Partners is a world leader in B2B2C insurance and assistance, offering global solutions that span international health and life, travel insurance, automotive and assistance. Customer driven, our innovative experts are redefining insurance services by delivering future-ready, high-tech high-touch products and solutions that go beyond traditional insurance. Our products are embedded seamlessly into our partners’ businesses or sold directly to customers, and are available through four commercial brands: Allianz Assistance, Allianz Automotive, Allianz Travel and Allianz Care.

102851 | Project Management | Professional | [[filter11]] | Allianz Partners | Full-Time | Permanent