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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in adjudicating outpatient medical claims, ensuring compliance with CPT and ICD coding guidelines, and conducting utilization reviews. Proficient in maintaining productivity targets while utilizing data analytics and cloud-based tools within ethical standards.
Highest-signal resume keywords
Medical Claim AdjudicationUtilization ReviewCPT and ICD CodingCertified Medical CoderStakeholder Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical Practical ExperienceOutpatient Documentation ReviewAssessment of Medical NecessityCost-Containment ProtocolsData AnalyticsAI and Machine Learning ToolsCloud-Based ToolsDocumentation CoordinationTurnaround Time ManagementQuality Standards Compliance
Soft Skills
Strong English Communication SkillsInterpersonal AbilitiesStakeholder ManagementTeam CollaborationAdaptability
Tools & Technologies
MS OfficeExcelWordOutlookPowerPointData Governance Tools
Certifications & Qualifications
Certified Medical Coder
Industry Keywords
Outpatient ServicesInsurance ProviderBrokerTPAAbu Dhabi Market KnowledgeAl-Ain Market Knowledge
Tech Stack
Tools & technologiesCloud
About the role
Key responsibilities & impact- Work on a flexible shift basis as scheduled by the Team Leader in a 24/7 precertification team
- Adjudicate outpatient medical claims from technical and clinical perspectives
- Ensure decisions comply with policy terms and conditions, turnaround times and quality standards
- Review outpatient documentation, including consultation notes, diagnostic reports, laboratory results, radiology findings, prescriptions, treatment plans and follow-up notes
- Assess medical necessity and appropriateness of proposed treatment plans
- Request additional medical documentation and coordinate with providers when clarification is required
- Conduct utilization review of outpatient services, billed items, non-covered services, overutilization patterns, investigations and procedures
- Review claims according to CPT and ICD coding guidelines and insurance regulator requirements
- Apply cost-containment protocols and ensure alignment with network rules and negotiated tariffs
- Maintain daily productivity and service-level targets
- Use AI, machine learning, data, analytics and cloud-based tools responsibly under data governance, security and ethical-use standards
Requirements
What you’ll need- Bachelor’s of Dentistry / Nursing / Paramedics
- 1-3 years of Medical Practical Experience
- Experience with a reputable insurance provider, broker or TPA is a plus
- Physically fit to carry out duties
- Certified Medical Coder preferable
- Legally permitted to work in the country of operations
- Fluency in MS Office (Excel, Word, Outlook, PowerPoint)
- General internet navigation and research skills
- Strong English communication skills, verbal and written
- Excellent interpersonal and stakeholder management abilities
- Abu Dhabi and Al-Ain Market knowledge
Benefits
Comp & perks- Equal opportunities and inclusive workplace
- AI, Business Intelligence, Data Analytics, Information Security Management and emerging technology environment
- Opportunities to explore, grow and shape a better future
- Potential regular rotation across functions, Allianz entities and geographies