Medical Officer

• Manage outpatient precertification claims while meeting departmental goals, activity timelines, and compliance measures
• Work flexible shifts according to the Team Leader’s schedule 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 against evidence-based guidelines and outpatient benefit structures
• Request additional medical documentation and coordinate with providers when clarification is needed
• Conduct utilization reviews of outpatient services, billed items, non-covered services, overutilization patterns, investigations, and procedures
• Review claims according to CPT and ICD coding guidelines and insurance regulators’ requirements (DHA, DOH/HAAD, MOH)
• Apply cost-containment protocols and verify alignment with network rules and negotiated tariffs
• Maintain daily productivity and service-level targets for timely adjudication and consistent workflow management
• Use AI, machine learning, data, analytics, and cloud-based tools responsibly according to data governance, security, and ethical-use standards

Explore Medical Officer – Outpatient Precertification at Allianz. Review requirements and application details.