Medical Officer
As a member of Munich Re the Oman MedNet Group is a leading Third-Party Administrator across the MEA region. We are currently looking for a “Officer -Medical Care Unit” the job holder is expected to handle pre-approvals pertaining to outpatient Or In-patient cases and correspond with network providers for pre-approval requisitions.
Your Job:
- Review and process outpatient and inpatient pre-authorization requests in line with medical policies and benefits.
- Assess medical necessity based on clinical information, medical guidelines, and policy terms.
- Ensure accurate medical coding, approvals, documentation, and system updates.
- Process pharmacy authorization requests within required turnaround times.
- Provide clear rationale for decisions while maintaining accuracy, quality, and medical ethics.
- Identify and escalate suspected fraud or abuse and unusual medical trends.
- Handle provider queries, second opinions, and case management efficiently.
- Manage changing workloads and shift-based duties while meeting quality and productivity targets.
Your Profile:
Minimum Qualifications & Experience:
- Bachelor’s degree in Nursing or Pharmacy, preferred.
- Minimum 2–3 years of experience in the UAE managed care industry.
- Good knowledge of health insurance concepts and the UAE healthcare system.
- Proficient in MS Office, including Excel and PowerPoint.
- Good command of written English.
- Strong interpersonal and negotiation skills.
Good analytical, problem-solving, planning, and organizational skills.
*Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunity employer.