MedNet Egypt is one of the leading managed care service organizations that caters to healthcare needs. We are looking for a skilled Medical Team Leader who will manage and direct the approvals team (Inpatient/ Outpatient or both) to assure that all requests are assessed & completed accurately in terms of Quality & SLA according to scope of coverage and medical Guidelines. Assuring effectiveness of workflow in the Medical department along with work distribution to the team.
Your Role
- Oversee inpatient medical operations and ensure team productivity meets set targets and SLAs.
- Conduct daily audits of medical approvals to ensure compliance with policy coverage and procedures.
- Identify and investigate potential fraud or abuse cases from providers or clients.
- Provide medical and technical guidance to department staff and support international accounts.
- Plan and schedule manpower to optimize operational efficiency.
- Participate in regional transformation projects and support other MedNet operations when needed.
- Lead, coach, and develop staff to enhance performance and maintain processing quality.
- Review treatment plans against medical guidelines, arrange second medical opinions, and monitor admitted cases.
- Manage case steering by negotiating hospital costs, securing better treatment options, and maintaining referral matrices.
- Handle provider, client, and insurer inquiries to ensure timely resolution and service excellence.
- Prepare regular performance and medical trend reports, highlighting savings and operational outcomes.
- Maintain accurate medical records, update chronic medication reports, and ensure proper documentation filing.
Your Profile
- Bachelor's degree in medicine.
- four years experience in his/her educational field.
- Experience in medical approval, call center and/or claims activities in the insurance industry or a TPA/MSO company would be a plus.
- Computer literacy (MS Office, Excel, PowerPoint)
- Good command in English
- Excellent written and verbal communication skills
- Strong leadership, planning and organizational skills
- Analytical and problem-solving skills and database management skills
- Decision making skills
