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.
