Medical Reviewer – Claims, Approvals & Coding Expert

Munich Re Group; Dubai; Vor Ort; AED 180.000 - 300.000; Vollzeit

Zusammenfassung

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.

Qualifikationen

• 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.

Aufgaben

• 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.

Kenntnisse

Medical coding

Case management

Clinical evaluation

Ausbildung

MBBS or equivalent

Jobbeschreibung

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.