Medical Reviewer

MedNet Global Healthcare Solutions LLC; Dubai; On-site; AED 180,000 - 280,000; Full time

Job summary

MedNet Global Healthcare Solutions LLC in the UAE is seeking a Medical Reviewer for the Medical Care Unit to evaluate inpatient and outpatient cases, review medical records, and support pre-approvals for insured members. You will collaborate with healthcare providers, apply DRG-based cost-containment, and deliver timely guidance to the Claims team while maintaining high service standards for clients.

The role requires MBBS or equivalent and 2–3 years of relevant experience within a TPA/MSO

Qualifications

• Medical Degree (MBBS or equivalent) from a WHO-recognized school.
• 2–3 years in Medical Claims Evaluation / In-Patient Approvals / Case Management in Insurance.
• Certified Medical Coder (CPT/ICD/DRGs) with DRG debates experience.
• Knowledge of the local healthcare system.

Responsibilities

• Evaluate and assess healthcare needs by reviewing records, policies, and treatment plans with providers and clients.
• Assess risk exposure in line with underwriting policies.
• Manage queries from providers, insurers and insured members regarding approvals.
• Provide medical guidance to Claims Department and assist in coding and DRG reviews.
• Deliver excellent customer service to insurers and members and monitor performance/trends.
• Attend hospital visits for case management and fraud prevention.
• Compile data and prepare monthly reports on medical trends and department performance.

Skills

Medical claims evaluation

Case management

Medical coding (CPT/ICD/DRGs)

Provider/customer query handling

Underwriting policies

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 & 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.

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