Medical Reviewer

For MedNet Global Healthcare Solutions

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.

*Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunities employer.