Medical Reviewer

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 calls / queries relating to calls / queries relating to pre-approvals.

Your Role:

• Evaluate claims (Network & Direct), provide authorizations for insured members (in-patient & outpatient) and handle calls relating to medical cases efficiently.
• Assess risk exposure of members in line with medical underwriting policies.
• Manage queries from providers, Insurance Companies and insured members relating to pre-approval decisions, evaluation and administration.
• Provide medical guidance to the Claims Department staff and assistance in ICD coding.
• Deliver excellent customer service to Insurance Companies and insured members with a view of achieving maximum client satisfaction.
• Client Management / attending hospital visits to investigate on claims in order 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 preferably from TPA / MSO organization in Insurance sector.
• Certified Medical Coder (CPT/ ICD / DRGs).
• Industry knowledge related to local healthcare services system.
• Good interpersonal and negotiation skills
• Excellent written and verbal communication skills
• Strong leadership, planning and organizational skills
• Analytical and problem-solving skills
• Ability to handle stress.

Minimum Qualifications:

• University degree in MBBS from a school recognized by the WHO
• Certified Medical Coder (CPT/ ICD / DRGs).

Minimum Experience:

• 2-3 years of experience in Medical Claims Evaluation preferably from TPA / MSO organization in Insurance sector.