Sector
Government Health Programmes
Analytics and audit for self-insured government health schemes.
Consulting data scientist for the Dubai Health Authority and the Department of Health, Abu Dhabi. Utilization analysis, electronic audit of claims, DRG reconciliation, and evidence for tariff negotiations — work that affects hundreds of thousands of beneficiaries.
Client
Organisation
DHA · DoH Abu Dhabi
Engagement Type
Health Analytics Consultancy
At a glance
100k+
Beneficiaries affected by policy work
M+
Claims reviewed
10%+
Manual review reduction via audit pipeline
2
Government authorities served
Context
Self-insured programmes like DHA's and DoH's Thiqa cover large populations and carry large fiscal exposure. Utilization, pricing, and provider behaviour all need continuous, evidence-based scrutiny. My engagements focused on putting the data and automated audit infrastructure in place to make that scrutiny routine rather than episodic.
Capabilities
- Utilization reports for self-insured government programmes
- Cost driver analyses supporting tariff negotiations
- Electronic audits of claims at population scale
- DRG data analysis and reconciliation
- ML-driven anomaly detection for billing irregularities
- Executive reporting for health policy leadership
Projects
Work delivered.
DHA Self-Insured Programmes
Utilization reports and cost driver analyses enabling data-driven adjustments to programmes covering hundreds of thousands of beneficiaries.
— Utilization— Policy
DoH Thiqa Audit
Audit of the Thiqa programme. Evidence for tariff structure optimisation; material expenditure impact.
— Audit— Tariffs
Electronic Audit Pipeline
Automated anomaly detection and electronic audits on large-scale claims data. Rule-based and ML systems flagging irregularities; manual review time reduced by over 10%.
— Automation— ML
DRG Reconciliation
Reconciliation system for Diagnosis-Related Group claims. Standardised pricing methodology across providers.
— DRG— Pricing
Next step