Medical Reviewer: Claims Evaluation & Care Authorization

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

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