Medical Officer

• Manage Inpatient Precertification cases 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 inpatient precertification cases and authorize decisions within stipulated turnaround times
• Perform complete file reviews of clinical and billing documentation
• Request missing medical documentation essential for decision-making
• Review DRG Severity of Illness and CPT/ICD coding, discussing issues with treating doctors and medical coders when required
• Perform utilization reviews for DRG and FFS cases, including final bills, consumable markups, non-covered items/services, and overutilization
• Review claims according to CPT and ICD coding guidelines and UAE insurance regulator requirements
• Adhere to cost-containment protocols
• Refer cases for second opinions and lower-cost network facilities or home-country treatment when necessary
• Use AI, machine learning, data, analytics, and cloud-based tools responsibly in accordance with data governance, security, and ethical-use standards

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