Summary
MedNet, a member of the Munich Re Group, is hiring a Medical Reviewer for its Medical Care Unit in Dubai. The role reviews medical records, policies and treatment plans; assesses member risk; manages pre-approval queries; and supports claims staff with medical guidance and coding. Duties also include case management, hospital visits to investigate claims, cost containment and preparing monthly reports. Applicants need an MBBS or equivalent from a WHO-recognized school, 2–3 years of relevant insurance-sector experience, and medical coding certification in CPT, ICD or DRGs.
The posting
As published on mednet-uae.com. Pulled from the employer's site and shown as they wrote it.
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.