Medical Reviewer: Claims, Underwriting & Case Mgmt

MedNet Global Healthcare Solutions LLC (MN-GHS) BU; Dubai; On-site; AED 180,000 - 280,000; Full time

Job summary

MedNet Global Healthcare Solutions LLC (MN-GHS) BU in Dubai seeks a Medical Reviewer to evaluate inpatient and outpatient cases, review medical records, policies and treatment plans in collaboration with providers and clients.

Your role includes assessing risk exposure, performing DRG debates, supporting claims decisions, coding guidance, and ensuring timely pre-approvals with a focus on cost containment and patient satisfaction.

Qualifications

• MBBS or equivalent medical degree required.
• 2-3 years in medical claims evaluation, in-patient approvals or case management preferred.
• Certified Medical Coder with CPT/ICD/DRGs experience required, DRG debates knowledge advantageous.

Responsibilities

• Evaluate and assess healthcare needs by reviewing medical records, policies and treatment plans with providers and clients.
• Assess risk exposure according to medical underwriting policies.
• Perform DRG debates and contribute to cost-containment efforts.
• Provide quick, accurate responses to queries from providers, insurers, and insured members.
• Offer medical guidance to Claims Department and assist in accurate coding and LTC reviews.
• Deliver high-quality customer service to insurers and insured members to maximize satisfaction.
• Conduct case management and hospital visits to investigate claims and minimize fraud.
• Compile data and prepare monthly reports on departmental performance and trends.

Skills

Medical Claims Evaluation

In-Patient Approvals

Case Management

Education

MBBS or equivalent Medical Degree

Certified Medical Coder (CPT/ICD/DRGs)

Job description

MedNet Global Healthcare Solutions LLC (MN-GHS) BU in Dubai seeks a Medical Reviewer to evaluate inpatient and outpatient cases, review medical records, policies and treatment plans in collaboration with providers and clients.

Your role includes assessing risk exposure, performing DRG debates, supporting claims decisions, coding guidance, and ensuring timely pre-approvals with a focus on cost containment and patient satisfaction.