Medical Claims Reviewer & Underwriting Specialist

MedNet Global Healthcare Solutions LLC; Dubai; Presencial; AED 167.000 - 234.000; Jornada completa

Descripción de la vacante

MedNet Global Healthcare Solutions LLC seeks an experienced Medical Claims Evaluation professional to review medical records, policies, and treatment plans. You will assess risk exposure, collaborate with underwriters, and manage inquiries from providers, insurers, and insured members to ensure accurate coding and DRG debates.

The role emphasizes cost-containment, quality service, and data-driven reporting, requiring a medical degree and 2-3 years in a similar Insurance sector role.

Formación

• Evaluate and assess healthcare needs of clients by reviewing medical records, insurance policies and treatment plans.
• Assess risk exposure of members in line with medical underwriting policies.
• Manage and respond to queries from Providers, Insurance Companies and insured members.
• Provide medical guidance to Claims Department and assist in accurate coding and DRG reviews.

Responsabilidades

• Deliver excellent customer service to Insurance Companies and insured members.
• Attend hospital visits for case management and fraud reduction.
• Compile monthly data and prepare statistics for department trends.

Conocimientos

Medical Claims Evaluation

Case Management

Provider communication

Underwriting collaboration

Educación

MBBS or equivalent

Herramientas

CPT/ICD/DRG coding

Descripción del empleo

MedNet Global Healthcare Solutions LLC seeks an experienced Medical Claims Evaluation professional to review medical records, policies, and treatment plans. You will assess risk exposure, collaborate with underwriters, and manage inquiries from providers, insurers, and insured members to ensure accurate coding and DRG debates.

The role emphasizes cost-containment, quality service, and data-driven reporting, requiring a medical degree and 2-3 years in a similar Insurance sector role.