Medical Reviewer

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 Medical Reviewer - Medical Care Unit, who will be responsible to provide services related to medical evaluations/authorizations for (in-patient & outpatient) insured members/providers and handle queries relating to pre-approvals. Your Role: • Evaluate and assess the healthcare needs of clients, including reviewing medical records, insurance policies, and treatment plans by active collaboration with healthcare providers and clients. • Assess risk exposure of members in line with medical underwriting policies. • Evaluate case to achieve optimum member s satisfaction, adhere to strict TATs and manage cost-containment via prescribed maneuvers like DRG debates • Quick and accurate management of queries from Providers, Insurance Companies and Insured members relating to approvals • Provide medical guidance to the Claims Department staff and assistance in accurate coding, Add-on/LTC reviews. • Deliver excellent customer service to Insurance Companies and insured members with a view of achieving maximum client satisfaction. • Case Management/attending hospital visits to investigate claims to minimize fraud and abuse. • Compile data and prepare monthly statistical reports to monitor departmental performance and medical trends. Your Profile: • Medical Degree (MBBS or equivalent) from a school recognized by the WHO. • 2-3 years of experience in Medical Claims Evaluation/In-Patient Approvals/Case Management preferably from TPA / MSO organization in Insurance sector. • Certified Medical Coder (CPT/ICD/DRGs) with relevant experience in DRG debates and Severity negotiations • Industry knowledge related to local healthcare services system.