Regulatory Affairs Specialist - Health Insurance

The Regulatory Affairs Specialist will be responsible for analyzing new and existing regulations in relation to an organization's products or processes and ensuring compliance with applicable Health and Federal regulations that have an impact on Health Line of Business. This role encompasses managing, coordinating, and responding to regulatory queries/escalations from both internal and external stakeholders, handling and managing regulatory complaints, regulatory reporting and conducting thorough audits. The Regulatory Affairs Specialist will also be expected to document regulatory processes and conduct quality check inspections in conjunction with regulations, policies, and procedures.

Key Responsibilities:

• Regulatory Compliance Framework: Develop, maintain, and continuously improve the regulatory compliance framework, policies, standards, and procedures for the department, ensuring alignment with relevant laws and regulations.
• Expert Advisory: Deliver consistent, high-quality advice and solutions for all regulatory queries and escalations, both internally and externally, adhering to the highest compliance standards.
• Regulatory Advisory Leadership: Set priorities for the Regulatory Advisory relationship by collaborating with Business Heads and other Control functions to ensure timely and accurate regulatory advice, solutions, and reporting.
• Engagement with Regulators: Foster relationships with regulators in the UAE (DHA, DOH, MOH, Central Bank) and other Gulf Region regulatory bodies, facilitating open communication and compliance collaboration.
• Licensing and Reporting: Maintain close liaison with regulatory bodies, ensuring timely acquisition of necessary licenses, consents, ad hoc notifications, periodic regulatory reporting, and information provision upon request.
• Industry and Regulatory Updates: Stay current with industry and regulatory changes affecting governance in the region and proactively plan for compliance, including conducting timely due diligence and providing training to stakeholders.
• Regulatory Complaints: Handle, manage, and help resolve regulatory complaints, ensuring that complaints are addressed in accordance with regulatory requirements and organizational policies.
• Drive Compliance Culture: Promote a culture of pro-active correspondent regulatory compliance across the Employee Benefits organization and support regulatory/compliance change initiatives.
• Risk Assessment and Due Diligence: Assist in compliance assessments, operational risk controls assessments, and due diligence processes, including World checks and process controls.
• Ex-Gratia and Operational Loss Assessment: Conduct primary validation of any Ex-Gratia and Operational Loss Assessment requests raised by the business for Employee Benefits.
• Record Keeping: Maintain accurate records related to regulatory breaches, fines, regulatory complaints, training and competence, conflict identification and management, communications and marketing, client-related documentation, regulatory projects, notifications made, correspondence with regulators, and individuals' declarations and undertakings.
• Monitoring and Surveillance: Conduct quarterly proactive and reactive audit/quality check monitoring and surveillance, reporting findings to the line Manager, and implementing necessary enhancements to regulatory mandates and controls.
• AML/KYC and Transaction Monitoring: Perform AML/KYC and transaction monitoring checks in a timely manner to ensure compliance with regulatory requirements.
• Regulatory Audit Support: Support all regulatory audit requirements and, where applicable, assist Compliance, Audit, Risk, and Legal teams in reviewing Health and Compliance audit items and implementing agreed-upon actions and mitigants.
• Regulatory Projects: Actively participate in and support regulatory projects aimed at enhancing compliance and governance within the organization.

Operational & technical responsibilities:

Operational Responsibilities:

• Complaint Intake: Receive and document all regulatory complaints promptly, ensuring all necessary details are captured accurately.
• Complaint Triage: Assess the severity and potential impact of each complaint, categorizing them for appropriate handling and prioritization.
• Investigation and Documentation: Conduct thorough investigations into regulatory queries, escalations and complaints, gathering relevant information and evidence. Maintain comprehensive records of the investigative process.
• Root Cause Analysis: Identify and analyze the root causes of regulatory breaches to understand underlying issues and potential areas for process improvement.
• Regulatory Reporting: Prepare and submit regulatory reports as required by regulatory authorities, ensuring that data is accurate and complete.
• Escalation Management: Collaborate with relevant stakeholders to elevate critical or complex queries/complaints and ensure their timely resolution.
• Resolution and Communication: Work closely with internal teams to develop solutions and action plans to address regulatory demands. Communicate resolution findings, actions and updates to affected parties.
• Follow-Up and Monitoring: Implement monitoring mechanisms to track progress in resolving complaints, ensuring corrective actions are effective and preventive measures are in place.

Technical Responsibilities:

• Complaint Management System: Utilize specialized software or systems designed for complaint management to track and document complaints throughout their lifecycle.
• Regulatory Knowledge: Stay updated on regulatory requirements and guidelines relevant to the industry and region, ensuring that complaint handling processes align with these regulations.
• Data Analysis: Use data analytics tools and techniques to identify trends and patterns in regulatory changes and demands.
• Documentation Standards: Maintain documentation in compliance with regulatory standards, ensuring records are accurate, complete, and organized for audits or inspections.
• Reporting Tools: Use reporting tools to generate reports summarizing complaint data, trends, and outcomes for both internal and external stakeholders.
• Continuous Improvement: Contribute to the development and enhancement of the complaint management system and associated processes to streamline and improve efficiency.
• Training and Education: Provide training to relevant personnel on regulatory mandates, complaints, AML-KYC procedures and compliance requirements.
• Audit Readiness: Prepare the organization for upcoming regulatory audits by conducting mock audits, assessments, and readiness exercises. Collaborate with teams to ensure timely closure of audit findings and recommendations. Monitor progress and verify that agreed-upon actions and mitigants are implemented effectively. Assist in the review of audit documentation to ensure completeness, accuracy, and alignment with regulatory expectations.
• Bachelor’s Degree
• Minimum of 3-4 years’ experience is a must in similar Governance/Compliance/Audit role in the Health Insurance in the UAE .
• Must have knowledge of Health Regulations in the UAE (DHA, DOH, MOHAP, CBUAE) and
• knowledge of Health Regulations in Oman, Bahrain and Qatar
• Strong communication skills – Both English and Arabic(preferred) -written and verbal
• Excellent analytical abilities
• Attention to detail and quality standards.
• Interpersonal skills- Must demonstrate the ability to build relationships with key stakeholders at all levels within an organization.
• Problem solving and effective decision making.
• Good time management skills - must be able to work effectively in a demanding environment
• where strict timelines and protocols must be met.

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