Medical Reviewer

MedNet Global Healthcare Solutions LLC; Dubai; On-site; AED 167,000 - 234,000; Full time

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Medical Claims Evaluation

Case Management

Provider communication

Underwriting collaboration

Education

MBBS or equivalent

Tools

CPT/ICD/DRG coding

Job description

MedNet Global Healthcare Solutions LLC (MN-GHS) BU

4 days ago

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.

*Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunities employer.