Job Description

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.
Job Overview
Job Posted:
3 days ago
Job Expire In:
1w 5d
Job Type
Full Time
Job Role
Executive
Education
Bachelor Degree
Experience
2 Years