Medical Officer – Inpatient Precertification

About the role

The Medical Officer – Inpatient Precertification ensures timely and accurate adjudication of inpatient pre‑certification cases, supporting cost‑containment and quality standards for our insurance operations.

Key responsibilities

• Work flexible 24/7 shifts as scheduled by the team leader.
• Adjudicate inpatient pre‑certification cases, authorizing decisions within stipulated turnaround times.
• Conduct comprehensive file reviews of multidisciplinary notes, orders, lab and radiology reports, drug charts, and progress notes.
• Request missing documentation and ensure all necessary information is available for decision‑making.
• Review DRG Severity of Illness, CPT/ICD coding, and discuss discrepancies with physicians and coders.
• Perform utilization reviews for DRG and fee‑for‑service cases, including bill verification, consumable markup analysis, and detection of non‑covered or over‑utilized services.
• Validate claims against CPT/ICD guidelines and regulatory requirements (DHA, DOH/HAAD, MOH).
• Apply cost‑containment protocols and refer cases for second opinions when needed.
• Leverage AI, machine learning, and analytics tools while adhering to data governance and security standards.

Required profile

• Bachelor’s degree in Pharmacy, Dentistry, Medicine, Nursing, Physiotherapy or Paramedics.
• 1–2 years of medical practical experience in insurance, brokerage or TPA environments, or entry‑level candidates.
• Physically fit and legally permitted to work in the UAE.
• Certified Medical Coder (preferred).
• Proficient in MS Office (Excel, Word, Outlook, PowerPoint) and internet research.

Required skills

• Microsoft Excel
• Microsoft Word
• Microsoft Outlook
• Microsoft PowerPoint
• Medical coding (CPT, ICD)

What we offer

• Opportunity to work with a global leader in B2B2C insurance and assistance.
• Innovative environment leveraging AI and data analytics.
• Exposure to international health, life, travel, and automotive insurance solutions.