High-Impact Case Management & Utilization Review Specialist

Allianz Services; Abu Dhabi; On-site; AED 900,000 - 1,500,000; Full time

Job summary

Allianz Partners Abu Dhabi seeks a Case Management Utilization Review Specialist to manage high-cost cases, ensure compliance, and meet timelines. You will collaborate with the Case Management team to develop protocols and provide training.

The role reports to the Assistant Manager – Case Management Utilisation Review. Requirements include MBBS and 5+ years of medical practice, insurance industry knowledge is a plus, and MS Office proficiency.

Qualifications

• Bachelor’s degree in Medicine (MBBS) required.
• 5+ years of medical practice experience.
• Knowledge of insurance industry practices is a plus.
• Legally permitted to work in the country.
• Physically fit to carry out duties.
• Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation.

Responsibilities

• Liaise with Case Management team to develop and implement protocols and provide training.
• Identify and report clinical cost drivers to plan Field Control Officers or File Reviews.
• Manage high risk and long stay cases.
• Evaluate provider and clinician abuse to flag issues and create cost-control frameworks.
• Coordinate with BD Team & Payers to manage expectations from Case Management.
• Audit and sign off monthly Case Management Savings report and share with Assistant Manager.
• Manage jumbo discounts above 250k AED claim value.
• Coordinate with Providers and vendors for cost-effective outcomes on elective cases.
• Ensure timely closure of disputed cases with insurance payers.
• Aim for monthly savings target of AED 1M and work with Audit and Fraud Waste teams.

Skills

MS Office

Education

Bachelor’s of Medicine (MBBS)

Job description

Allianz Partners Abu Dhabi seeks a Case Management Utilization Review Specialist to manage high-cost cases, ensure compliance, and meet timelines. You will collaborate with the Case Management team to develop protocols and provide training.

The role reports to the Assistant Manager – Case Management Utilisation Review. Requirements include MBBS and 5+ years of medical practice, insurance industry knowledge is a plus, and MS Office proficiency.