Medical Reviewer

Job Description

<p><strong>For MedNet Global </strong></p><p><br></p><p>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 <strong>“Medical Reviewer – Medical Care Unit</strong>”, who will be responsible to provide services related to medical evaluations / authorizations for (in-patient &amp; outpatient) insured members / providers and handle calls / queries relating to calls / queries relating to pre-approvals.</p><p><br></p><p><strong>Your Role:</strong></p><ul><li>Evaluate claims (Network &amp; Direct), provide authorizations for insured members (in-patient &amp; outpatient) and handle calls relating to medical cases efficiently.</li><li>Assess risk exposure of members in line with medical underwriting policies.</li><li>Manage queries from providers, Insurance Companies and insured members relating to pre-approval decisions, evaluation and administration.</li><li>Provide medical guidance to the Claims Department staff and assistance in ICD coding.</li><li>Deliver excellent customer service to Insurance Companies and insured members with a view of achieving maximum client satisfaction.</li><li>Client Management / attending hospital visits to investigate on claims in order to minimize fraud and abuse.</li><li>Compile data and prepare monthly statistical reports to monitor departmental performance and medical trends.</li></ul><p><br></p><p><strong>Your Profile:</strong></p><ul><li>Medical Degree (MBBS or equivalent) from a school recognized by the WHO. </li><li>2-3 years of experience in Medical Claims Evaluation preferably from TPA / MSO organization in Insurance sector.</li><li>Certified Medical Coder (CPT/ ICD / DRGs).</li><li>Industry knowledge related to local healthcare services system.</li><li>Good interpersonal and negotiation skills</li><li>Excellent written and verbal communication skills </li><li>Strong leadership, planning and organizational skills</li><li>Analytical and problem-solving skills</li><li>Ability to handle stress.</li></ul><p><br></p><p><strong>*Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunity employer.</strong></p>