AVP Compliance | Financial Services| Orient Insurance PJSC
1. Health Insurance Regulatory Compliance – Primary Responsibility
Review products, policy terms, underwriting, enrolment, claims, pre-authorization, reimbursement and complaints for regulatory compliance.
Oversee compliance risks relating to provider networks, brokers, outsourcing partners and TPAs, including due diligence, contracts, service levels, data access and audit rights.
Monitor laws, regulations, standards, circulars, notices and other requirements issued by the Dubai Health Authority (DHA) and the Department of Health in Abu Dhabi and ensure coordination with the above authorities.
Coordinate with Health Insurance, Claims, Underwriting, Operations, IT and other relevant departments to ensure timely implementation of regulatory requirements.
Maintain an updated register of applicable health insurance regulatory requirements and monitor the Company’s compliance with such requirements.
Review health insurance policies and procedures from a regulatory compliance perspective.
Support the preparation and submission of regulatory reports, responses, confirmations and other information required by the relevant health authorities.
Coordinate and follow up on regulatory inspections, reviews, audits, observations and remediation actions relating to health insurance.
Monitor regulatory deadlines and ensure that required actions and submissions are completed within the prescribed timelines.
Escalate material compliance issues, regulatory breaches or implementation delays to the VP
- Compliance.Promote fair customer outcomes and transparent disclosures in health insurance activities and monitor health insurance complaints from a regulatory compliance perspective.
Provide compliance support in relation to financial crime controls and medical-fraud investigations; advise on privacy, consent, confidentiality, retention and health-data sharing.
Execute risk-based reviews, report findings, establish accountable actions, validate closure and escalat material breaches.
Maintain appropriate documentation and evidence demonstrating compliance with applicable regulatory requirements.
Follow up with business units on agreed compliance remediation actions and report overdue or material matters to the VP
- Compliance.Assist VP
- Compliance in preparing compliance reports, maintain regulatory records, deliver targeted training and support enterprise-wide compliance initiatives.
Monitor compliance with applicable insurance laws, regulations, standards and regulatory circulars.
Conduct regulatory gap assessments and support implementation of new regulatory requirements.
Review internal policies, procedures, products, agreements and business initiatives from a compliance perspective.
Support the preparation and updating of the Compliance Framework, Compliance Plan and related policies and procedures.
Perform any other compliance-related duties assigned by the VP
- Compliance.
Bachelor’s degree in law, Finance, Business, Insurance, Healthcare Administration or a related field; relevant professional qualification preferred.
Typically, 10–12 years’ relevant experience, including 5 years in a managerial or senior advisory role.
Strong knowledge of UAE insurance regulation and practical medical-insurance experience.
Experience with regulators, inspections, remediation and senior governance forums.
Understanding of medical underwriting, claims, provider contracting, TPAs, coding, billing, outsourcing and health-data risks.
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