Medical Officer - Precertification Associate

Role overview

Claims review and adjudication

• Adjudicate outpatient claims from clinical and technical perspectives under policy terms and conditions.
• Review medical records, diagnostic reports, prescriptions, treatment plans, and follow-up notes for medical necessity and appropriate care.
• Assess treatment plans against evidence-based guidelines and outpatient benefits; request missing records and seek provider clarification.
• Conduct utilization review of billed items, non-covered services, overutilization, investigations, and procedures.
• Apply CPT and ICD coding guidelines and applicable DHA, DOH/HAAD, and MOH requirements.
• Follow cost-containment protocols, network rules, and negotiated tariffs; meet daily productivity and service-level targets.

Schedule

• The precertification team operates 24/7; the Medical Officer works flexible shifts according to the Team Leader's schedule.

Candidate requirements

• Bachelor's degree in Dentistry, Nursing, or Paramedics.
• 1–3 years of practical medical experience; insurance-provider, broker, or TPA experience is a plus.
• Medical coder certification is preferable.
• Fluency in MS Office and general internet navigation and research skills.
• Strong spoken and written English, interpersonal, and stakeholder-management skills.
• Abu Dhabi and Al-Ain market knowledge; legally permitted to work in the country of operations.

AI readiness

• Work responsibly with AI, machine learning, data, analytics, and cloud-based tools, following data-governance, security, and ethical-use standards.