Medical Reviewer

Munich Re Group; Dubai; On-site; AED 180,000 - 300,000; Full time

Job summary

Munich Re Group's MedNet Group in the MEA region is seeking a Medical Reviewer for the Medical Care Unit. You will evaluate medical records, authorise in-patient and outpatient treatments, and collaborate with providers and clients to ensure appropriate care.

You will ensure adherence to medical underwriting policies, manage DRG debates, support the Claims Department with coding, and deliver timely, accurate decisions on pre-approvals to minimize costs and maximize member satisfaction.

Qualifications

• Must hold MBBS or equivalent degree from a WHO-recognized medical school.
• 2-3 years of experience in medical claims evaluation, in-patient approvals or case management.
• Certified Medical Coder (CPT/ICD/DRGs) with DRG debates experience.

Responsibilities

• Evaluate and assess healthcare needs by reviewing medical records and treatment plans with providers and clients.
• Assess risk exposure and align with medical underwriting policies.
• Evaluate cases to achieve optimum member satisfaction and timely approvals for pre-authorizations.
• Manage queries from providers, insurers, and insured members relating to approvals.
• Compile data and monitor departmental performance and medical trends.

Skills

Medical coding

Case management

Clinical evaluation

Education

MBBS or equivalent

Job 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 amp 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

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