Medical Recovery Negotiator

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.