Medical Review Officer (UAE National Only)
Daman
Abu Dhabi, UAE
منذ 6 يوم

Job Description

  • Evaluate medical necessity and consistency of diagnosis, procedures, drug codes and descriptions stated on the claims according to accepted medical coding rules and guidelines , Ensure accurate application of contractual prices and discounts, schedule of benefits, general exclusions, allocation of benefits, collection of deductibles, co-
  • payments, observance of policy limits, and adherence to claims submission protocols

  • Escalate observations about providers’ billing and coding trends to the supervisor. Report fraud and abuse cases to Medical Investigation and Audit Department according to set policies and procedures
  • Contribute in developing, updating and implementing the guidelines for evaluation and processing of medical claims, as well as policies and procedures and work instructions related to medical claims review and processing
  • Ensure that business decisions and processes are documented in a professional way and the communication requirements are being adhered to in a timely and professional manner
  • Deliver high quality customer service and respects medical and work ethics at all times
  • Consistently, efficiently and effectively work on achieving the daily targets, quality benchmarks and other key performance indicators (KPIs)
  • Skills

  • Good command of written and spoken English; knowledge of Arabic language is an advantage
  • Good analytical, execution, problem solving and decision making skills
  • Ability to acquire and apply new skills
  • Flexible and able to work under pressure
  • Respect and maintain a high level confidentiality
  • Good computer and keyboard skills as well as competency with Microsoft Office
  • Ability to acquire and apply new skills
  • Flexible and able to work under pressure
  • Respect and maintain a high level confidentiality
  • Proactive and results oriented whilst ensuring high quality of work
  • Advanced level of customer service orientation and professionalism in all interactions
  • Able to manage a multi-cultural environment and promote teamwork and knowledge sharing in order to achieve goals and deliverables
  • Good knowledge of health insurance concepts
  • Good knowledge of Microsoft applications
  • قدِّم طلب ترشيحك
    أضف الى المفضلات
    إزالة من الإشارات المرجعية
    قدِّم طلب ترشيحك
    بريدي الالكتروني
    بالنقر فوق "متابعة"، عطي نيوفو الموافقة على معالجة بياناتي وإرسال تنبيهات البريد الإلكتروني لي، وفقًا لسياسة الخصوصية الخاصة بنيوفو. يمكنني إلغاء اشتراكي أو سحب موافقتي في أي وقت.
    واصل
    استمارة الطلب