Medical Claims Analyst

Overview

Your role

• Monitor and review pre-approvals in coordination with the insurance team, ensuring timely and clinically appropriate feedback on case management interventions.
• Conduct comprehensive coding reviews on all inpatient approvals to ensure compliance with ICD, CPT, and DRG standards.
• Implement evidence-based cost containment strategies, including provider negotiations, second medical opinions, and home country referral facilitation in collaboration with the insurance team.
• Periodically analyze outpatient claims to identify utilization trends, provider performance patterns, and document suspected fraud, waste, and abuse for escalation.
• Establish and maintain approval thresholds for different Third-Party Administrators (TPAs) in collaboration with insurance partners to ensure alignment with clinical quality and cost efficiency objectives.
• Provide clinical expertise and assistance in health insurance medical underwriting processes as required
• Review medical evidence and recommend appropriate coverage determinations
• Support risk assessment activities in collaboration with the underwriting team

Your Profile

• Bachelor's degree in Medicine (MD/MBBS) or equivalent medical qualification
• Current Certification in Medical Coding and Billing (e.g., AAPC, ICD-10, or equivalent regional certification)
• Minimum 3 years of hands-on experience in health insurance claims management in the UAE market
• Additional insurance qualifications (e.g., AICL, RPA) are highly desirable.
• Excellent problem-solving and time management skills
• Good interpersonal and communicational skills
• Team player, motivated, dependable, and open-minded
• Assertive, reliable and business-minded with good negotiation skills.
• Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunities employer.