Medical Reviewer – Medical Care Unit

About the role

Join the MedNet Group, a leading Third‑Party Administrator in the MEA region, as a Medical Reviewer in the Medical Care Unit. You will evaluate medical records, authorizations and provide guidance to ensure optimal member satisfaction while managing costs.

Key responsibilities

• Review medical records, insurance policies and treatment plans in collaboration with providers and clients.
• Assess risk exposure according to underwriting policies and manage pre‑approval queries from providers, insurers and members.
• Conduct DRG debates, severity negotiations and cost‑containment measures while meeting strict turnaround times.
• Provide medical coding guidance, support claims staff and assist with add‑on/LTC reviews.
• Perform case management, including hospital visits to investigate claims and prevent fraud.
• Compile monthly statistical reports on departmental performance and medical trends.

Required profile

• Medical Degree (MBBS or equivalent) recognized by WHO.
• 2‑3 years experience in medical claims evaluation, inpatient approvals or case management, preferably in a TPA/MSO insurance environment.
• Certified Medical Coder with experience in CPT, ICD and DRG coding and negotiations.

Required skills

• CPT coding
• ICD coding
• DRG coding and debates