Description
Job description / Role
Job Type
Full Time
Job Location
Abu Dhabi, UAE
Nationality
Any Nationality
Salary
Not Specified
Gender
Not Specified
Arabic Fluency
Not Specified
Job Function
Healthcare
Company Industry
Insurance
Medical officer - inpatient precertification responsibilities
Medical officer - inpatient precertification is responsible for managing the inpatient precertification cases while ensuring that departmental goals, timeline of activities, and compliance measures are met.
What you do
The precertification team is functional on a 24/7 basis. Therefore, the medical officer will be working on a flexible shift basis as per the schedule provided by the team leader.
Responsibilities include:
Adjudicates cases at inpatient precertification level, authorizes decisions within the stipulated turnaround time and with the highest quality standards in view of the policy terms and conditions.
Performs complete file review with regards to multidisciplinary notes, TPR charts, physician orders' notes, lab reports, radiology reports, drug chart sheets, consultation notes, nursing notes, progress notes, etc.
Requests any medical documentation or finds any missing documents which are essential in decision making.
Performs review of DRG severity of illness (SOI) in line with revision of CPT codes / ICD codes, which are being up-coded by the provider; if required, discusses with the treating doctor and the medical coders.
Performs utilization review for DRG cases and FFS cases with regards to, but not limited to, final bill review, consumables mark-ups, non-covered items/services, and overutilization of services.
Performs review of claims as per CPT and ICD coding guidelines in line with insurance regulators (DHA, DOH/HAAD, MOH).
Adheres to cost containment protocols for medical management cases.
Refers cases for second opinion when deemed necessary to confirm the best mode of management; also for cost containment by recommending facilities with lower negotiating factors within the member's network or options for home country treatment.
AI readiness
Work effectively in an environment shaped by artificial intelligence (AI), machine learning, data, analytics, and cloud-based tools, using insights responsibly with our standards of data governance, security, and ethical use.
What you bring
Bachelor's of Medicine (MBBS), Bachelor of Nursing, or Pharmacy.
1-2 years medical experience (reputable insurance provider, broker, or TPA experience is a plus).
Knowledge of overall insurance industry practices is a plus.
Legally permitted to work in the country of operations.
Physically fit to carry out duties.
Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.
Agency statement
Allianz Partners does not accept unsolicited CVs or approaches from agencies. We only work with partners on our approved supplier list, under contract. Any unsolicited submission will not be considered.
What we offer
Allianz Partners is a world leader in B2B2C insurance and assistance, offering global solutions that span international health and life, travel insurance, automotive, and assistance. Customer driven, our innovative experts are redefining insurance services by delivering future-ready, high-tech high-touch products and solutions that go beyond traditional insurance.
Our products are embedded seamlessly into our partners' businesses or sold directly to customers, and are available through four commercial brands: Allianz Assistance, Allianz Automotive, Allianz Travel, and Allianz Care.
At Allianz Partners, artificial intelligence (AI) is transforming service delivery and innovation. By leveraging business intelligence and data analytics, we enhance strategic decision-making and customer experiences. Our commitment to ethical AI ensures responsible deployment, maintaining data integrity and trust. Conversational AI improves communication, while emerging technologies and generative AI drive industry leadership and new opportunities. With robust information security management, we protect sensitive information, ensuring compliance and security. Embrace the future of AI with Allianz Partners, where possibilities become realities.
Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams, and challenges is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow, and to shape a better future for our customers and the world around us.
At Allianz, we stand for unity: we believe that a united world is a more prosperous world, and we are dedicated to consistently advocating for equal opportunities for all. The foundation for this is our inclusive workplace, where people and performance both matter, and nurtures a culture grounded in integrity, fairness, inclusion, and trust.
We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, social class, disability, sexual orientation, or any other characteristics protected under applicable local laws and regulations.
Great to have you on board. Let's care for tomorrow.
Additional information
Having different strengths, experiences, perspectives, and approaches is an integral part of Allianz's company culture. One means to achieve this is a regular rotation of Allianz executive employees across functions, Allianz entities, and geographies. Therefore, the company expects from its employees a general openness and a high motivation to regularly change positions and collect experiences across Allianz Group.
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