Medical Officer - IP

Nextcare; Abu Dhabi; On-site; AED 150,000 - 220,000; Full time

Job summary

Nextcare in Abu Dhabi is seeking a Medical Officer for Inpatient Precertification. The role involves managing precertification cases, conducting comprehensive file reviews, and ensuring compliance with regulatory standards. Candidates should possess a Bachelor’s of Medicine (MBBS) with at least one year of clinical experience. Familiarity with the insurance sector is advantageous. Responsibilities include reviewing claims and working in a dynamic environment shaped by AI and analytics while adhering to company protocols.

Qualifications

• At least 1 year of clinical practice or relevant nursing experience.
• 1–2 years of medical experience in insurance settings is a plus.
• Legally permitted to work in the UAE.

Responsibilities

• Manage Inpatient Precertification cases ensuring compliance and standards.
• Review medical documentation for decision making.
• Perform reviews according to CPT and ICD coding guidelines.

Skills

Clinical practice

MS Office proficiency

Insurance industry knowledge

Education

Bachelor's of Medicine (MBBS) or Bachelor of Nursing

Job description

Medical Officer – Inpatient Precertification is responsible for managing the Inpatient Precertification cases while ensuring departmental goals, timeline of activities, and compliance measures are met.

Responsibilities

• Precertification team is functional on a 24/7 basis. Therefore the Medical Officer will work on a flexible shift basis as per the schedule provided by the Team Leader.
• Adjudicates cases at IP precertification level, authorizing decisions within the stipulated turnaround time and with the highest quality standards in view of the policy terms and conditions.
• Performs a complete file review with regard to the multidisciplinary notes, TPR charts, physician order notes, lab reports, radiology reports, drug chart sheets, consultation notes, nursing notes, progress notes, etc.
• Requests any medical documentation or identifies any missing documents essential for decision making.
• Performs review of DRG Severity of Illness (SOI) in line with revision of CPT codes/ICD codes, which are being up‑coded by the provider – if required, discusses with the treating doctor and the medical coders.
• Performs utilization review for DRG cases and FFS cases, including final bill review, consumables mark‑ups, non‑covered items/services, and overutilization of services.
• Reviews claims according to CPT and ICD coding guidelines in line with insurance regulators (DHA, DOH/HAAD, MOH).
• Adheres to cost containment protocols for medical management cases.
• Refers cases for a second opinion when deemed necessary to confirm the best mode of management – also for cost containment to less negotiating‑factor (NF) facilities within the member’s network or option for home‑country treatment.
• AI Readiness: Works effectively in an environment shaped by artificial intelligence (AI), machine learning, data, analytics, and cloud‑based tools, using insights responsibly with standards of data governance, security and ethical use.

Qualifications

• Bachelor’s of Medicine (MBBS) with at least 1 year of clinical practice or Bachelor of Nursing.
• 1–2 years of medical experience (reputable insurance provider, broker or TPA experience is a plus).
• Knowledge of overall insurance industry practices is a plus.
• Legally permitted to work in the country of operations.
• Physically fit to carry out duties.
• Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.

Agency Statement

Allianz Partners does not accept unsolicited CVs or approaches from agencies. We only work with partners on our approved supplier list, under contract. Any unsolicited submission will not be considered.

Equal Opportunity Statement

At Allianz, we stand for unity: we believe that a united world is a more prosperous world, and we are dedicated to consistently advocating for equal opportunities for all. Our foundation is an inclusive workplace, where people and performance both matter, and we nurture a culture grounded in integrity, fairness, inclusion, and trust. We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristics protected under applicable local laws and regulations.