Medical Officer - Outpatient Precertification

About the role

Allianz Partners is hiring a Medical Officer for its Outpatient Precertification function in Dubai. The role manages outpatient precertification claims while meeting departmental goals, activity timelines and compliance measures. The precertification team works 24/7, so the Medical Officer works flexible shifts set by the Team Leader.

Key responsibilities

• Adjudicate outpatient medical claims from technical and clinical perspectives, complying with policy terms and conditions and meeting turnaround time and quality standards.
• Review outpatient documentation such as consultation notes, diagnostic reports, lab results, radiology findings, prescriptions, treatment plans and follow-up notes to validate medical necessity.
• Assess proposed treatment plans against evidence-based guidelines and outpatient benefit structures.
• Request additional documentation or coordinate with providers when clarification is needed.
• Conduct utilization review of outpatient services, including billed items, non-covered services, overutilization patterns and appropriateness of investigations or procedures.
• Review claims according to CPT and ICD coding guidelines in line with insurance regulators (DHA, DOH/HAAD, MOH).
• Ensure services are medically justified, appropriately billed and aligned with network rules and negotiated tariffs.
• Maintain daily productivity and service level targets.
• Work in an AI-enabled environment, using data, analytics and cloud tools responsibly with data governance and security standards.

Required profile

• Bachelor's degree in Dentistry, Nursing or Paramedical fields.
• 1-3 years of practical medical experience; experience with a reputable insurer, broker or TPA is a plus.
• Physically fit to carry out duties.
• Legally permitted to work in the country of operation.
• Fluent English, verbal and written, with strong interpersonal and stakeholder management skills.
• Knowledge of the Abu Dhabi and Al Ain markets is a plus.

Required skills

• Certified Medical Coder (preferable)
• MS Office (Excel, Word, Outlook, PowerPoint)
• Internet navigation and research skills