Medical Officer - Inpatient Precertification Associate

About the role

Allianz Partners is hiring a Medical Officer for its Inpatient Precertification function. The officer manages inpatient precertification cases while meeting departmental goals, activity timelines and compliance measures. The precertification team works 24/7, so the Medical Officer works on a flexible shift basis set by the Team Leader.

Key responsibilities

• Adjudicate cases at the inpatient precertification level, authorizing decisions within the stipulated turnaround time and in line with policy terms and conditions.
• Review complete files including multidisciplinary notes, TPR charts, physician orders, lab and radiology reports, drug charts, consultation and nursing notes, and progress notes, and request any missing documents needed for the decision.
• Review DRG Severity of Illness (SOI) in line with CPT and ICD code revisions, discussing with the treating doctor and medical coders when needed.
• Perform utilization reviews for DRG and FFS cases, covering final bills, consumables markups, non-covered items and overutilization.
• Review claims according to CPT and ICD coding guidelines in line with insurance regulators (DHA, DOH/HAAD, MOH).
• Follow cost-containment protocols for medical management cases, refer cases for second opinion when needed, and negotiate network facility factors or home-country treatment options.
• Work in an AI-enabled environment, using data, analytics and cloud tools responsibly with data governance, security and ethical standards.

Required profile

• Bachelor of Medicine/Surgery (MBBS) is mandatory.
• 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.
• Knowledge of the Abu Dhabi and Al Ain markets.
• Notice period of maximum 1 month.

Required skills

• Certified Medical Coder (preferable)
• Fluent MS Office (Excel, Word, Outlook, PowerPoint) and internet research skills
• Strong written and spoken English, with good stakeholder management