Medical Reviewer – MNSPC

5 days ago

Muscat, Muscat, Oman MedNet Global Healthcare Solutions LLC Full time

Medical Reviewer – MNSPC

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" This position provides services related to medical evaluations / authorizations for (in-patient & outpatient) insured members / providers and handle calls relating to medical cases.

Your Role:

Medical Claims Evaluation:

Evaluate claims (Network & Direct), provide authorizations for insured members (in-patient & outpatient) and handle calls relating to medical cases efficiently.

Assess risk exposure of members in line with medical underwriting policies.

Deliver excellent customer service to Insurance Companies and insured members with a view of achieving maximum client satisfaction.

Client 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.

Business Correspondence:

Manage queries from providers, Insurance Companies and insured members relating to claims processing, evaluation and administration.

Provide medical guidance to the Claims Department staff and assistance with ICD coding.

Client Servicing:

Deliver excellent customer service to Insurance Companies and insured members with a view of achieving maximum client satisfaction.

Client Management / attending hospital visits to investigate claims in order to minimize fraud and abuse.

Your profile:

Minimum Requirements:

  • Medical University degree in MBBS/ MD. (Only MBBS graduates will be considered).
  • Fresh Graduates or candidates with 2-3 years of experience in Medical Claims Evaluation preferably from TPA / MSO organization in the Insurance sector
  • Computer literacy (MS Office, Excel, PowerPoint)
  • Industry knowledge related to local healthcare services system
  • Good interpersonal and negotiation skills
  • Excellent written and verbal communication skills
  • Strong leadership, planning and organizational skills
  • Analytical and problem-solving skills

*Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunities employer.

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