Medical Reviewer (United Arab Emirates) Dubai

Requirements

Candidates must hold a Medical Degree (MBBS or equivalent) and possess 2-3 years of experience in medical claims evaluation or case management. A certification in medical coding (CPT/ICD/DRGs) and knowledge of local healthcare systems are required.

Job Summary

As a member of Munich Re the MedNet Group is a leading Third-Party Administrator across the MEA region. We are currently seeking to hire a Medical Reviewer – Medical Care Unit, who will be responsible to provide services related to medical evaluations/authorizations for (in-patient & outpatient) insured members/providers and handle queries relating to pre-approvals.
Your Role:
Evaluate and assess the healthcare needs of clients, including reviewing medical records, insurance policies, and treatment plans by active collaboration with healthcare providers and clients.
Assess risk exposure of members in line with medical underwriting policies.
Evaluate case to achieve optimum member’s satisfaction, adhere to strict TATs and manage cost-containment via prescribed maneuvers like DRG debates
Quick and accurate management of queries from Providers, Insurance Companies and Insured members relating to approvals
Provide medical guidance to the Claims Department staff and assistance in accurate coding, Add-on/LTC reviews.
Deliver excellent customer service to Insurance Companies and insured members with a view of achieving maximum client satisfaction.
Case Management/attending hospital visits to investigate claims to minimize fraud and abuse.
Compile data and prepare monthly statistical reports to monitor departmental performance and medical trends.

Your Profile:
Medical Degree (MBBS or equivalent) from a school recognized by the WHO.
2-3 years of experience in Medical Claims Evaluation/In-Patient Approvals/Case Management preferably from TPA / MSO organization in Insurance sector.
Certified Medical Coder (CPT/ICD/DRGs) with relevant experience in DRG debates and Severity negotiations
Industry knowledge related to local healthcare services system.
*Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunities employer.

Responsibilities

The Medical Reviewer evaluates healthcare needs, assesses insurance claims, and manages pre-approvals to ensure cost-containment and member satisfaction. They also provide medical guidance to the claims department and compile statistical reports on medical trends.

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