Medical Claims Officer

6 hours ago

Muscat, Muscat, Oman Nextcare Full time
Key Responsibilities / What You Do:
  • The precertification team operates 24/7; therefore, the Medical Officer will work on a flexible shift basis according to the schedule provided by the Team Leader.
  • Adjudicate cases, authorize decisions within the stipulated turnaround time, ensuring the highest quality standards in accordance with policy terms and conditions.
  • Perform comprehensive file reviews, including multidisciplinary notes, TPR charts, physician orders, lab reports, radiology reports, drug charts, consultation notes, nursing notes, and progress notes.
  • Request any necessary medical documentation or identify missing documents essential for decision-making.
  • Review DRG Severity of Illness (SOI) in line with CPT and ICD code revisions, including discussions with treating doctors and medical coders if required, especially in cases of up-coding by providers.
  • Conduct utilization reviews for DRG and FFS cases, including final bill review, consumables markups, non-covered items/services, and overutilization of services.
  • Review claims according to CPT and ICD coding guidelines, complying with insurance regulators (DHA, DOH/HAAD, MOH).
  • Adhere to cost containment protocols for medical management cases.
  • Refer cases for second opinions when necessary to confirm the best management approach, including cost containment strategies such as negotiating with NF facilities within the member's network or considering treatment in the member's home country.
Key Requirements / What You Bring:
  • Bachelor's of Medicine (MBBS) with 1 year of clinical practice OR Bachelor of Nursing.
  • 1-2 years of medical experience; experience with reputable insurance providers, brokers, or TPAs is a plus.
  • Knowledge of the insurance industry practices is advantageous.
  • Legally permitted to work in the country of operations.
  • Physically fit to perform duties.
  • Proficiency in MS Office (Excel, Word, Outlook, PowerPoint) and strong internet research skills.
Key Benefits / What We Offer:

Our employees are integral to our success. We recognize the unique needs and ambitions of each individual and support their journey through various development programs and courses. Our global environment encourages mobility and career growth. We prioritize your health and wellbeing through Work Well programs, providing flexibility for work-life balance.

As part of Allianz Group, one of the world's most trusted insurance and asset management companies, we are committed to caring for our employees and fostering a diverse, inclusive workplace. We welcome applications from all backgrounds, regardless of ethnicity, age, gender, nationality, religion, disability, or sexual orientation. Join us and help shape a better future for our customers and the world around us.

#J-18808-Ljbffr

  • Medical Claims Officer Position

    2 hours ago

    Muscat, Muscat, Oman beBee Careers Full time

    Job SummaryWe are seeking a skilled Medical Claims Officer to join our team. As a key member of our organization, you will be responsible for adjudicating medical cases, authorizing decisions, and performing comprehensive file reviews.Main Responsibilities:Adjudicate medical cases within the stipulated turnaround time, ensuring high-quality standards in...

  • Medical Claims Officer

    4 weeks ago

    Muscat, Muscat, Oman Nextcare Full time

    Key responsibilities/What you do:Precertification team is functional on 24/7 basis. Therefore, the Medical Officer will be working on flexible shift basis as per the schedule provided by the Team Leader.Adjudicates Cases, authorizes decision within the stipulated turnaround time & with the highest quality standards in view with the policy terms and...

  • Medicine Medical Officer

    4 weeks ago

    Muscat, Muscat, Oman The Medical City for Military & Security Services Full time

    Medical Officer In MedicineThe Medical City for Military and Security ServicesMuscat, Sultanate of OmanThe Medical City for Military and Security Services (MCMSS) in Muscat Oman is a Tertiary/Quaternary Care level city providing services to patients of different age groups in different specialties.MCMSS is seeking to appoint Medical Officer In Medicine, who...

  • Medical Officer

    3 days ago

    Muscat, Muscat, Oman Sultan Qaboos Comprehensive Cancer Center Full time

    Medical Officer at Sultan Qaboos Comprehensive Cancer CenterLocation: Muscat, Sultanate of OmanThe Sultan Qaboos Comprehensive Cancer Care & Research Center (SQCCCRC) in Muscat, Oman, is a Quaternary care level center specializing in adult solid malignancies (excluding hematological malignancies).We are seeking a highly motivated Medical Officer to develop...

  • Medical Officer

    6 days ago

    Muscat, Muscat, Oman Sultan Qaboos Comprehensive Cancer Center Full time

    Medical OfficerSultan Qaboos Comprehensive Cancer Care and Research CenterUniversity Medical CityMuscat, Sultanate of OmanThe Sultan Qaboos Comprehensive Cancer Care & Research Center (SQCCCRC) in Muscat Oman a Quaternary care level center providing care for adult patients with solid malignancies (No hematological malignancies).SQCCCRC is seeking to appoint...

  • Insurance Claims Operations Expert

    1 week ago

    Muscat, Muscat, Oman beBee Careers Full time

    About the Role:This is an exciting opportunity for an experienced Claims Executive to join our team in Omani National role. The successful candidate will be responsible for ensuring the smooth and efficient processing of claims, maintaining compliance with regulations and policies.Key Accountabilities:Oversee the claims processing workflow, coordinating the...

  • Medical Officer Position

    3 days ago

    Muscat, Muscat, Oman beBee Careers Full time

    We are seeking a highly motivated Medical Officer to develop their professional career within our comprehensive cancer center. The ideal candidate will have a basic medical degree from a recognized institution and a minimum of two years post-internship experience dealing with adult patients with various medical conditions.ResponsibilitiesAdhere to policies,...

  • Medical Billing Review Expert

    2 hours ago

    Muscat, Muscat, Oman beBee Careers Full time

    Job PurposeThe purpose of this role is to provide expert-level support in medical claims adjudication and review. The successful candidate will have a strong understanding of medical terminology, coding systems, and insurance industry regulations. Key responsibilities include:Main Responsibilities:Perform comprehensive file reviews, including medical records...

  • Medicine Medical Officer

    3 weeks ago

    Muscat, Muscat, Oman MOD Full time

    Direct message the job poster from The Medical City for Military & Security ServicesRecruiter - The Medical City for Military & Security ServicesMedical Officer In MedicineThe Medical City for Military and Security ServicesMuscat, Sultanate of OmanThe Medical City for Military and Security Services (MCMSS) in Muscat Oman is a Tertiary/Quaternary Care level...

  • Medical Officer in Internal Medicine

    1 week ago

    Muscat, Muscat, Oman beBee Careers Full time

    About the RoleWe are seeking a highly skilled Medical Officer In Medicine to deliver high-quality patient care and participate in teaching and training activities.As a Medical Officer, you will be responsible for developing health education programs and maintaining adherence to policies, guidelines, plans, and programs.This role offers an exciting...