Medical Evaluation Officer
Abu Dhabi, UAE
منذ 20 يوم

Job Description

  • Evaluate the medical necessity and consistency of diagnosis and procedure stated on the claims according to accepted international guidelines and guidelines for the specific country.
  • Evaluate authorization / extension requests for complex hospitalization cases (mainly from US and Europe).
  • Process, evaluate / adjudicate and audit within the agreed timeframe and with the expected quality.
  • Contribute in developing, updating and implementing international guidelines
  • Effectively liaise with providers, member and other stakeholders (answering phone calls, replying to emails etc.) in a timely and professional manner
  • Support the claims adjudicators and case managers in dealing with complex medical related enquiries, reviewing medical reports and selecting suitable medical providers and conducting occasional follow up calls with the medical providers to check deviations in the scheduled treatments.
  • Participate in special projects, preparation of reports and presentations.
  • Lead discussion with medical providers and clients regarding the medical trends and guidelines.
  • Actively propose new initiatives to control medical costs.
  • Work shift wise as required
  • Skills

  • Good command of written and spoken English; knowledge of Arabic and additional languages (French, Spanish, German, Korean) is an advantage
  • Good knowledge of international guidelines and regulations
  • Good analytical, execution, problem solving and decision making 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
  • Advance level of customer service orientation and professionalism in all interactions
  • Able to work in 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
  • Medicine

    قَدِّم طلبك ترشيحك
    قَدِّم طلبك 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.
    استمارة الطلب