Medical Officer - Precertification Associate
Role Overview
The Medical Officer – Outpatient Precertification manages outpatient precertification claims and supports departmental goals, timelines, and compliance.
The precertification team operates 24/7; the Medical Officer works flexible shifts according to the Team Leader’s schedule.
Key Skills for This Role
Full Job Posting
Role overview
The Medical Officer – Outpatient Precertification manages outpatient precertification claims and supports departmental goals, timelines, and compliance.
The precertification team operates 24/7; the Medical Officer works flexible shifts according to the Team Leader’s schedule.
Responsibilities
- Adjudicate outpatient claims using clinical and technical review, policy terms, turnaround times, and quality standards.
- Review medical records and supporting documentation to assess necessity and appropriateness of care.
- Assess treatment plans against evidence-based guidelines and outpatient benefits; request missing documentation from providers.
- Conduct utilization review of billed items, non-covered services, overutilization, investigations, and procedures.
- Apply CPT and ICD coding guidelines and relevant insurance regulator requirements.
- Apply cost-containment protocols and check billing against network rules and negotiated tariffs.
- Meet daily productivity and service-level targets and maintain timely claim workflows.
- Use AI, data, analytics, and cloud tools responsibly in line with data governance, security, and ethical-use standards.
Qualifications and skills
- Bachelor’s degree in Dentistry, Nursing, or Paramedics.
- One to three years of medical practical experience.
- Insurance provider, broker, or TPA experience is a plus; medical coder certification is preferable.
- Fluency in MS Office, internet navigation, and research; strong spoken and written English and stakeholder-management skills.
- Knowledge of the Abu Dhabi and Al-Ain markets.
- Must be legally permitted to work in the country of operations.
Schedule
- The team operates around the clock and the role works flexible shifts as scheduled by the Team Leader.
Additional work context
The role involves working with AI, machine learning, data, analytics, and cloud-based tools under data-governance, security, and ethical-use standards.
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