Description
Job description / Role
Job Type
Full Time
Job Location
Dubai, 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 operates 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.
Key responsibilities include:
Adjudicating cases at inpatient precertification level, authorizing decisions within the stipulated turnaround time and with the highest quality standards in line with policy terms and conditions.
Performing complete file reviews with regard to multidisciplinary notes, TPR charts, physician order notes, lab reports, radiology reports, drug chart sheets, consultation notes, nursing notes, progress notes, etc.
Requesting any medical documentation or identifying missing documents essential for decision making.
Reviewing DRG severity of illness (SOI) in line with revision of CPT codes and ICD codes, addressing any up-coding by the provider; discussing with the treating doctor and medical coders if required.
Performing utilization review for DRG cases and fee-for-service (FFS) cases, including final bill review, consumables mark-ups, non-covered items/services, and overutilization of services.
Reviewing claims as per CPT and ICD coding guidelines in line with insurance regulators (DHA, DOH/HAAD, MOH).
Adhering to cost containment protocols for medical management cases.
Referring cases for second opinion when necessary to confirm the best mode of management and for cost containment by considering lower negotiating factor (NF) facilities 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 of Medicine (MBBS), Bachelor of Nursing, or Bachelor of Pharmacy.
1-2 years medical experience; experience with reputable insurance providers, brokers, or third-party administrators (TPA) 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.
How we hire
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 submissions 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. We are united by a shared commitment: to put our customers first and at the center of everything we do. Their needs inspire our thinking and guide our actions. Together, we can build an environment where everyone feels empowered and confident to explore, grow, and shape a better future—for our customers and for 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 where integrity, fairness, inclusion, and trust are at the heart of our culture. We therefore welcome applications regardless of race, 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.
Note
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 employees across functions, Allianz entities, and geographies. Therefore, Allianz 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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