Medical Officer

6 months ago


Dubai, United Arab Emirates TPA Full time

**RESPONSIBILITIES AND DUTIES**

Research and follow up on Medical Treatment patterns and conduct utilization reviews for Beneficiaries (Policyholders) & Medical Network providers, Quality control by:

- Being available (On call) 24 hours a day for Claim Centre Officers queries relating to in-patient claims.
- Assess day-care and in-patient cases as per medical justification and policy coverage.
- Issuing day-care and in-patient cases within AED 15,000.00 for medically justified cases in line with the policy.
- Escalate and confirm grey-area cases. Confirming of exclusions of borderline cases OP/IP.
- Assists CC officers and supervisors in claims adjudication cases as needed.
- Sending request of confirmation and notification to corresponding payers as needed.
- Responding to payer's queries in relation to day-care and In-patient cases.
- Responding to the payers request for advice on coverage of cases.
- Monitor Claims cost as per internal guidelines.
- Rejecting medically unjustified and policy wise excluded day-care and in-patient cases to be signed by Chief Medical Officer.
- Conformity of assessment for the prescribed tests/medications/investigations/clinical procedures
- Issuing day-care and In-patient cases Reimbursement Approval in line with medical and policy coverage.
- Contacting provider for queries and clarifications.
- Doing clinical discussion directly with the network's doctor as needed.
- Seeking verbal clinical opinion from Network's doctor as needed.
- Document and report to CC Supervisor, Assistant Manager and Manager any suspected fraud cases.
- Monitoring and maintaining the claims processing and adjudicating cycle in operational software system as per the defined terms and policy of the organization.
- Establishing strategies and implementing effective parameters for solving all possible queries within the team.
- Taking a lead role in assuring that the assigned tasks to the team are completed within the allocated time frame.
- Ensures the proper communication and implementation of new formats, training and processing rules.
- Entering and processing/ adjudicating claims in operational software system as per the terms and policy of the organization.
- Taking initiatives to maximize team efficiency.
- Maintaining both qualitative and quantitative claims measures.
- Achieving required processing targets assigned by the team-leader on daily, weekly and monthly basis.
- Monitor the qualitative and quantitative measures for IP-claims & pre-approvals.
- Ensure compliance to any changes in terms of system parameters or process.
- Assisting the CC Supervisors / Asst. Manager and Managers as needed.
- Any additional duties commensurate with your position as may be assigned to you from time to time by the Company.

**3.** **KNOWLEDGE, SKILLS AND EXPERIENCE**
- Medical Doctor (MBBS degree/ MD degree)
- 2 - 3 years’ experience in the healthcare industry/hospitals is mandatory
- Basic Industry knowledge (healthcare/insurance) is a plus.
- Should be a team-player with an aptitude for customer service
- Must be service oriented
- Highly decisive with outstanding logic and reasoning skills
- Excellent oral and written communication skills
- Must be computer literate
- Excellent command of the English language, Arabic is a plus
- Ability to work under pressure and meet tight deadlines and varying work-schedules

**Job Types**: Full-time, Permanent

Pay: AED9,000.00 - AED10,000.00 per month

**Education**:

- Bachelor's (preferred)

**Experience**:

- Hospital: 2 years (preferred)
- Medical Insurance: 1 year (preferred)



  • Dubai, United Arab Emirates Ziqitza Gulf Medical Full time

    Job Summary We are looking for a highly capable medical transcriptionist to transcribe voice recordings of medical consultations and procedures. In this role, you will be responsible for transcribing audio files, editing speech recognition transcripts, and formatting transcription reports. You may also be required to enter medical reports into electronic...

  • Medical Receptionist

    6 months ago


    Dubai, United Arab Emirates DermaMax Medical Center Full time

    Dmax Day Surgery Center is now hiring for qualified Receptionist with the following qualifications: Qualification: - 2 to 3 years of experience as receptionist in a MEDICAL RECEPTIONIST (AESTHETIC CLINIC) - Female - Lives in Dubai - Arabic & English speaking **Job Description**: - Greet and welcome guests as soon as they arrive at the office - Direct...

  • Medical Coder

    5 months ago


    Dubai, United Arab Emirates Biosytech Medical Laboratory Full time

    Minimum 3+ years experience in a similar role. - Bachelor’s Degree in any stream - Specialist in the area of claim resubmissions & reconciliations. - Medical Coding Certificate; RHIT or CPC by AAPC or AHIMA Certificate - Fluency in English (speak, read and write). Arabic speaking skills will be an added advantage. - Computer Literacy skills are required. -...


  • Dubai, United Arab Emirates Carenow Medical Equipment Full time

    Job Summary: Responsible for selling medical products and services to hospitals, clinics, doctors' offices, and healthcare professionals. Sells products such as medicines, drugs, and medical equipment to be used in general practices, primary care trusts, hospitals and pharmacies. Organizing sales visits Demonstrating/presenting products Maintaining...

  • Medical Coder

    6 months ago


    Dubai, United Arab Emirates Biosytech Medical Laboratory Full time

    Minimum 3+ years experience in a similar role. - Must have experience of managing claim submissions & resubmissions. - Bachelor’s Degree in any stream - Specialist in the area of claim resubmissions & reconciliations. - Medical Coding Certificate; RHIT or CPC by AAPC or AHIMA Certificate - Fluency in English (speak, read and write). Arabic speaking skills...

  • Medical Claims Officer

    6 months ago


    Dubai, United Arab Emirates Dubai Limited Investment Full time

    We are immediately hiring a Medical Claims Officer for our TPA Almadallah Healthcare Must have 5+ years experience in Medical Insurance/TPA experience as a Medical Claims Officer Qualification-MBBS (mandatory) Salary-8000-9000 AED/month Preference for immediate joiners Pay: AED9,000.00 - AED10,000.00 per month **Experience**: - TPA/Insurance: 1 year...

  • Medical Claims Officer

    6 months ago


    Dubai, United Arab Emirates Dubai Limited Investment Full time

    We are immediately hiring a Medical Claims Officer for our TPA Almadallah Healthcare Must have 5+ years experience in Medical Insurance/TPA experience as a Medical Claims Officer Qualification-MBBS (mandatory) Salary-8000-9000 AED/month Preference for immediate joiners Pay: AED8,000.00 - AED9,000.00 per month Application Question(s): - Do you have...

  • Medical Claims Officer

    4 months ago


    Dubai, United Arab Emirates Dubai Limited Investment Full time

    We are immediately hiring a Medical Claims Officer for our TPA Almadallah Healthcare Must have 5+ years experience in Medical Insurance/TPA experience as a Medical Claims Officer Qualification-MBBS (mandatory) Salary-8000-9000 AED/month Preference for immediate joiners Pay: AED10,000.00 - AED12,000.00 per month **Experience**: - TPA/Insurance: 3 years...

  • Medical Surgery Admin

    7 months ago


    Dubai, United Arab Emirates Padra Medical Center Full time

    **Job brief** We are looking for a Medical administrative assistant to organize our medical facility’s functions. You will support day-to-day operations by performing administrative tasks and ensuring high quality customer service for our patients. As a Medical administrative assistant, you will perform various tasks on a daily basis. So, you should be...

  • Medical Clinic

    3 months ago


    Dubai, United Arab Emirates TRANSFORM SPECIALIST MEDICAL CENTRE Full time

    **About Us**: Transform/HYF Medical Center is a premier healthcare facility in Dubai, specializing in longevity, anti-aging, and comprehensive wellness services. Our mission is to help our clients achieve optimal health and vitality through cutting-edge treatments and personalized care. We are committed to delivering exceptional patient care in a supportive...


  • Dubai, United Arab Emirates Dubai Limited Investment Full time

    We are immediately hiring a Medical Claims Officer for our TPA Almadallah Healthcare Must have 5+ years experience in Medical Insurance/TPA experience as a Medical Claims Officer Qualification-MBBS (mandatory) Salary-8000 AED/month Preference for immediate joiners Pay: AED8,000.00 per month **Experience**: - TPA/Insurance: 3 years (required) - IP...

  • Medical Receptionist

    8 months ago


    Dubai, United Arab Emirates Orthocure Medical Center -Mirdif Full time

    Medical Receptionist Job Responsibilities: Serves patients by greeting and helping them, scheduling appointments, and maintaining records and accounts. Welcomes patients and visitors in person or on the telephone, and answering or referring inquiries. Optimizes patients’ satisfaction, provider time, and treatment room utilization by scheduling...


  • Dubai, United Arab Emirates TRANSFORM SPECIALIST MEDICAL CENTRE Full time

    **IMPORTANT : PLEASE APPLY IF YOU HAVE PREVIOUS EXPERIENCE AS A MEDICAL RECEPTIONIST, DUBAI BASED. ( SALARY WILL DEPEND ON EXPERIENCE & QUALIFICATIONS )** **About Us**: Transform/HYF Medical Center is a premier healthcare facility in Dubai, specializing in longevity, anti-aging, and comprehensive wellness services. Our mission is to help our clients achieve...


  • Dubai, United Arab Emirates TRANSFORM SPECIALIST MEDICAL CENTRE Full time

    **About Us**: Transform/HYF Medical Center is a premier healthcare facility in Dubai, specializing in longevity, anti-aging, and comprehensive wellness services. Our mission is to help our clients achieve optimal health and vitality through cutting-edge treatments and personalized care. We are committed to delivering exceptional patient care in a supportive...

  • Customer Care Officer

    6 months ago


    Dubai, United Arab Emirates Rayhan Gulf Medical center Full time

    To provide a range of reception and associated administrative services pertaining to patients. Customer care executives will answer and direct incoming calls to appropriate individuals/departments. Perform specified routine procedures such as greeting ,registration and billing, referring patients, answering routine/administrative enquiries, and general...


  • Dubai, United Arab Emirates FERDOWS MEDICAL CENTER LLC Full time

    **We need a person for office in Dubai, who have more than 5 years of experience in Health & Medical Insurances field.** **(Just Female Residence in Dubai)** **Salary negotiable** **Note**: **PLEASE DON'T CALL JUST SEND YOUR CV / RESUME ON WHATSAPP : 050 484 7442** Ability to commute/relocate: - Dubai: Reliably commute or planning to relocate before...


  • Dubai, United Arab Emirates MEONE MEDICAL CENTER Full time

    we are seeking a friendly and organized Medical Receptionist to join our team. The Medical Receptionist will be the first point of contact for patients and visitors, providing exceptional customer service and ensuring the smooth operation of the front desk. This role involves scheduling appointments, managing patient records, and assisting with various...


  • Dubai, United Arab Emirates TASCoutsourcing Full time

    Examine claims records and forms to determine whether the patient has medical insurance. - Review provisions of certificate or policy to determine the patient’s included medical coverage losses. - Negotiate claim settlements and make recommendations for legal action when settlements are deemed non-negotiable. - Complete logs, reports, forms and records to...


  • Dubai, United Arab Emirates P. Medical Center Full time

    The Medical Center Manager is a key leadership role responsible for overseeing the administrative, operational, and managerial aspects of the medical center. This individual will play a crucial role in ensuring the smooth functioning of the center, maintaining relationships with various stakeholders, and upholding compliance with regulatory standards. Key...

  • Medical Claims Officer

    6 months ago


    Dubai, United Arab Emirates Allianz Partners Full time

    **Summary** The Claims officer provides quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards. **Main Tasks** - Evaluates medical claims from the technical and medical perspectives as per policy terms and conditions. - Checks particular treatment plan is necessary for the...