Senior Case Management & Utilization Review Specialist

Allianz Services; Abu Dhabi; On-site; AED 360,000 - 480,000; Full time

Job summary

Allianz Partners in Abu Dhabi seeks a Mid-Level Case Management Utilization Review Specialist to lead high-cost healthcare cases, ensure timely closures, and uphold compliance within a dynamic health-insurance operations team.

Role focuses on protocol development, cost containment, and collaboration with providers, payers, and internal teams. Requires MBBS, 5+ years medical experience, UAE work eligibility, and strong MS Office skills.

Qualifications

• MBBS degree required.
• 5+ years medical practical experience.
• Experience with insurance providers is a plus.
• Legally permitted to work in UAE.
• Physically fit to carry out duties.

Responsibilities

• Liaise with the Case Management team to develop and implement case management protocols, as well as provide training for the team.
• Identifying and reporting clinical cost drivers to plan Field Control Officers or File Reviews.
• Managing high risk and long stay cases.
• Evaluating Provider & Clinician Abuse to red flag the team; create a framework for cost controls.
• Coordinating with BD Team & Payers to manage expectations from Case Management perspective.
• Auditing & signing off the monthly Case Management Savings report & sharing with the Assistant Manager.
• Manage Jumbo discounts above 250k AED claim value.
• Coordinate with Providers & vendors to get the best cost effective outcome for elective cases.
• Ensuring timely closure of disputed cases & cases pending with insurance payers.
• Achieve a monthly savings target of AED 1M in line with the criteria or methodology defined by the Line Manager and Head of Department.
• Work closely with Audit and Fraud Waste team to flag providers and clinicians with activities of misrepresentation or malpractice.
• Ensure timely reviews & decision making of High costs cases above AED 75,000.
• Assessing cases with multiple admissions and readmission to gauge provider practice and investigate medical negligence if any.
• AI READINESS: Work effectively in an environment shaped by AI, ML, data, analytics and cloud-based tools, using insights responsibly with data governance, security and ethical use.

Skills

Research skills

Analytical thinking

MS Office proficiency

Education

MBBS

Tools

MS Office

Job description

Allianz Partners in Abu Dhabi seeks a Mid-Level Case Management Utilization Review Specialist to lead high-cost healthcare cases, ensure timely closures, and uphold compliance within a dynamic health-insurance operations team.

Role focuses on protocol development, cost containment, and collaboration with providers, payers, and internal teams. Requires MBBS, 5+ years medical experience, UAE work eligibility, and strong MS Office skills.