Medical Officer

As a member of Munich Re the Oman MedNet Group is a leading Third-Party Administrator across the MEA region. We are currently looking for a Officer -Medical Care Unit the job holder is expected to handle pre-approvals pertaining to outpatient Or In-patient cases and correspond with network providers for pre-approval requisitions. Your Job: • Review and process outpatient and inpatient pre-authorization requests in line with medical policies and benefits. • Assess medical necessity based on clinical information, medical guidelines, and policy terms. • Ensure accurate medical coding, approvals, documentation, and system updates. • Process pharmacy authorization requests within required turnaround times. • Provide clear rationale for decisions while maintaining accuracy, quality, and medical ethics. • Identify and escalate suspected fraud or abuse and unusual medical trends. • Handle provider queries, second opinions, and case management efficiently. • Manage changing workloads and shift-based duties while meeting quality and productivity targets. Your Profile: Minimum Qualifications & Experience: • Bachelor s degree in Nursing or Pharmacy, preferred. • Minimum 2 3 years of experience in the UAE managed care industry. • Good knowledge of health insurance concepts and the UAE healthcare system. • Proficient in MS Office, including Excel and PowerPoint. • Good command of written English. • Strong interpersonal and negotiation skills. • Good analytical, problem-solving, planning, and organizational skills.