Job Description

The role involves claims adjudication and reconciliation, patient care navigation, pre-authorisation of medical services, medical case management, and administration of cross-border healthcare operations. Ensures appropriate utilisation of medical services by mediating between providers and internal stakeholders, while ensuring compliance with approved policies, Schedule of Benefits, and contracted tariffs. The position supports the development and optimisation of automation initiatives, including ownership of the authorisation auto-compute engine, and functions as an in-house TPA for Domestic Government relations projects. As a people leader, should supervises and guides teams, monitors productivity, quality, TATs, and KPIs, conducts performance appraisals, supports staffing and training initiatives, ensures business continuity, escalates suspected fraud or abuse, and drives continuous improvement of authorisation and pre-authorisation processes to safeguard organisational assets and reputation. The role is a key within the Medical Operations Division, responsible for delivering high-quality, cost-effective medical services in line with strategic objectives.

Qualifications

Bachelor's degree in Medicine, Nursing, or Pharmacy. Minimum 5 years' experience, including 2 years in a supervisory role. Master's degree and medical coding certification are advantages.
Job Types: Full-time, Permanent

Pay: AED5,000.00 - AED7,000.00 per month

Work Location: In person