Medical Recovery Negotiator

Описание

Mains Lab detects systematic overpayment in health insurance claims: phantom services, upcoding, treatment intensity inflation, unnecessary admissions. We are looking for a physician with a strong negotiation track record to turn that analytics into real recovered money for insurers in Saudi Arabia. What you will do Negotiate with provider administrators to recover overpayments and correct billing behaviour. Explain the evidence for each case clearly: clinical review, grounds for each denial, references to clinical guidelines, comparison with statistics of other doctors in the same specialty. Defend our position in meetings with providers' medical directors, CFOs and legal teams. Close signed agreements: repayment, offset against future payments, corrective action plans. Handle objections while keeping working relationships intact. Feed back to our analysts: which patterns hold up, which counter-arguments administrators use, what to strengthen in the model. Report to the insurer on recovered amounts, timelines and case status. What we are looking for Medical degree (MD/MBBS or equivalent); clinical practice is a plus. 5+ years in health insurance, TPA, managed care, medical audit or provider relations. A proven record of complex negotiations with concrete results: amounts recovered, agreements signed, disputes settled. Excellent English (B2-C1): running meetings, business correspondence, well-argued written positions. Working knowledge of coding and pricing: ICD-10-AM/CM, CPT/ACHI, DRG, adjudication logic. The ability to hold a position under pressure while finding a solution both sides can sign. Nice to have Experience in KSA or the GCC; knowledge of the CHI market and the NPHIES platform. Background in FWA, claims audit, payment integrity or recovery. Certifications such as CPC, CCS, CHFP, AHFI or equivalent. What we offer A role with direct, measurable impact: every case is real money returned to a client. Strong analytics behind you: you walk into negotiations with data, not suspicions. Compensation: base + bonus tied to recovered amounts. Location: remote, with regular travel to Saudi Arabia for on-site negotiations with provider administrators. Employment type: full-time.