Medical Reviewer

MedNet Global Healthcare Solutions LLC (MN-GHS) BU; Dubai; On-site; AED 180,000 - 280,000; Full time

Job summary

MedNet Global Healthcare Solutions LLC (MN-GHS) BU in Dubai seeks a Medical Reviewer to evaluate inpatient and outpatient cases, review medical records, policies and treatment plans in collaboration with providers and clients.

Your role includes assessing risk exposure, performing DRG debates, supporting claims decisions, coding guidance, and ensuring timely pre-approvals with a focus on cost containment and patient satisfaction.

Qualifications

• MBBS or equivalent medical degree required.
• 2-3 years in medical claims evaluation, in-patient approvals or case management preferred.
• Certified Medical Coder with CPT/ICD/DRGs experience required, DRG debates knowledge advantageous.

Responsibilities

• Evaluate and assess healthcare needs by reviewing medical records, policies and treatment plans with providers and clients.
• Assess risk exposure according to medical underwriting policies.
• Perform DRG debates and contribute to cost-containment efforts.
• Provide quick, accurate responses to queries from providers, insurers, and insured members.
• Offer medical guidance to Claims Department and assist in accurate coding and LTC reviews.
• Deliver high-quality customer service to insurers and insured members to maximize satisfaction.
• Conduct case management and hospital visits to investigate claims and minimize fraud.
• Compile data and prepare monthly reports on departmental performance and trends.

Skills

Medical Claims Evaluation

In-Patient Approvals

Case Management

Education

MBBS or equivalent Medical Degree

Certified Medical Coder (CPT/ICD/DRGs)

Job description

Job Description - Medical Reviewer (2600000R)

Job Description

Medical Reviewer - ( 2600000R )

Description

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.

Qualifications

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.

Primary Location

AE-AE-Dubai

Work Locations

MN GHS Dubai Internet City Dubai

Job

Professional

Organization

MedNet Global Healthcare Solutions LLC (MN-GHS) BU

Schedule

Regular

Shift

Standard

Job Type

Full-time

Day Job