Inpatient Precertification Medical Officer (AI‑Ready)

Allianz Popular SL.; Abu Dhabi; On-site; AED 134,000 - 268,000; Full time

Job summary

Allianz Partners in Abu Dhabi is seeking a Medical Officer – Inpatient Precertification to manage inpatient precertification cases, ensuring timeliness, policy compliance, and patient safety. You will adjudicate cases 24/7, perform detailed file reviews of multidisciplinary notes, request missing documents, and work with physicians and coders to align CPT/ICD coding and DRG SOI.

This role emphasizes AI readiness, data-driven decision making, and cost containment while maintaining high-quality

Qualifications

• Bachelor's degree in MBBS, Nursing, or Pharmacy.
• 1–2 years medical experience, preferably with an insurer, broker, or TPA.
• Knowledge of insurance industry practices is a plus.
• Proficient in MS Office and internet research.

Responsibilities

• Precertification cases are managed on a 24/7 basis; work on flex shifts as scheduled.
• Adjudicates cases at IP precertification level, authorizes decisions within turnaround times and high quality standards.
• Perform complete file reviews including multidisciplinary notes, lab/radiology reports, physician orders, and nursing notes.
• Request missing medical documentation essential for decision making.
• Review DRG SOI and CPT/ICD codes; discuss with treating doctors and coders as needed.
• Conduct utilization reviews for DRG and FFS cases focusing on final bill review, consumables markups, and non-covered items.
• Ensure claims review aligns with CPT/ICD guidelines and regulatory requirements.
• Refer cases for second opinions when needed to confirm best management and cost containment.
• AI readiness: operate in an environment leveraging AI, data analytics, and cloud-based tools.

Skills

MBBS/Nursing/Pharm

1–2 years medical experience

Insurance knowledge

MS Office

Education

MBBS, Nursing or Pharmacy

Tools

MS Office

Job description

Allianz Partners in Abu Dhabi is seeking a Medical Officer – Inpatient Precertification to manage inpatient precertification cases, ensuring timeliness, policy compliance, and patient safety. You will adjudicate cases 24/7, perform detailed file reviews of multidisciplinary notes, request missing documents, and work with physicians and coders to align CPT/ICD coding and DRG SOI.

This role emphasizes AI readiness, data-driven decision making, and cost containment while maintaining high-quality