Medical Officer - Doctor - Insurance

Job description / Role

- Assess day-care and in-patient cases as per medical justification and policy coverage.
- Escalate and confirm grey-area cases. Confirming of exclusions of borderline cases OP/IP.
- Assists CC officers and supervisors in claims adjudication cases as needed.
- Sending request of confirmation and notification to corresponding payers as needed.
- Responding to payer's queries in relation to day-care and In-patient cases.
- Responding to the payers request for advice on coverage of cases.
- Monitor Claims cost as per internal guidelines.
- Rejecting medically unjustified and policy wise excluded day-care and in-patient cases to be signed by Chief Medical Officer.
- Conformity of assessment for the prescribed tests/medications/investigations/clinical procedures
- Issuing day-care and In-patient cases Reimbursement Approval in line with medical and policy coverage.
- Contacting provider for queries and clarifications.
- Doing clinical discussion directly with the network's doctor as needed.
- Seeking verbal clinical opinion from Network's doctor as needed.

Salary:
AED 9,000 to 10,000 per month inclusive of fixed allowances.
Additional benefits: Annual ticket, medical and life insurance

Requirements

- Medical Doctor (MBBS degree/ MD degree)
- 2 - 3 years’ experience in the healthcare industry/hospitals is mandatory
- Basic Industry knowledge (healthcare/insurance) is a plus.
- Should be a team-player with an aptitude for customer service
- Must be service oriented
- Highly decisive with outstanding logic and reasoning skills
- Excellent oral and written communication skills
- Must be computer literate
- Excellent command of the English language, Arabic is a plus
- Candidate must be tactful and discrete when dealing with clients and must be able to handle confidential information
- Ability to work under pressure and meet tight deadlines and varying work-schedules

About the Company

One of the leading “TPA” , Third Party Administrators in Medical Insurance ; a subsidiary of a fortune 20 Multi National Company , with extensive operation across GCC prospering over the last 18 years in facilitating our customers beyond their expectations in all services on par with global standards.

We are committed in ensuring to provide high quality , superior, innovative and cost-effective business solutions in the areas of healthcare and insurance services and embrace the good will of being one among the best leading TPA’s in this region serving over 50 insurance companies , in administering their multiple policies as well as catering to self-funded schemes with both international and local policies amidst our stake holders.

It is significant to share our accolades, that we serve more than 1.4 million members whilst administering over AED 4 billion worth of claims annually through a dedicated team of 700 + medical professionals in our talent pool from different parts of the world. We are partnered with a broad global network of over 4,000 health care providers in the region and always thrive to delight our customer through every service we provide remarkably.

We believe in attracting dynamic , focused , self-motivated , professionals with industry expertise to join hands with us to move forward in a journey, which promises growth and career establishment as per each one’s skills and potential.