Provider Engagement Officer

We are looking for a Provider Engagement Officer in our Provider Relations department in Dubai.

Provider Engagement Officer is responsible for representing the SAICOHEALTH as a case manager who coordinates cost-effective, high-quality medical care to help patients recover safely while minimizing financial risk for the insurance company.

The position manages the end-to-end coordination of escalated cases while maintaining strong, operational relationships with network doctors and hospital RCM teams.

This position also serves as the primary medical matchmaker for high-cost, high-risk cases, guiding premium members to top-tier doctors and facilities when required.

They build personal relationships with medical specialists and coordinate directly with hospital RCM to streamline pre-authorizations, billing, and complex discharge claims.

This position will be accountable for remote Disease Management program which includes reviewing patient-submitted health records to assess clinical status, deliver targeted health education, and drive self-management.

1.

Review medical records of escalated cases (High-cost/ Complex/ Disputed Cases) to ensure requested treatments are medically necessary and align with policy coverage guidelines.

2.

Assess the case based on escalation reason & resolve by taking up the discussion with internal departments and Providers.

3.

Identify high-quality, cost-effective care pathways which can be suggested to the member and the Provider for cost containment from an expensive treatment.

4.

Liaise with internal teams and the providers to negotiate additional discount on high-cost claims thereby finalizing single-case agreements (SCAs) with hospitals when requested.

5.

Maintain active, working relationships with hospital RCM staff, billing supervisors, and authorization departments to intervene in high-value claims or claim disputes to reach amicable, data-driven financial solutions and streamline high-cost claims.

6.

Collaborate with doctors, hospital Case Managers/ discharge planners and RCM teams to facilitate timely patient discharges to lower-cost care settings without compromising patient health and align clinical treatment plans with insurance authorization timelines.

7.

Serve as a direct, accessible, day-to-day contact for network doctors to resolve administrative queries, escalations, care variations or clinical process bottlenecks.

8.

Review complex or high-cost patient cases and actively recommend the most appropriate, cost-effective, high-quality doctors and facilities in the market as required.

9.

Provide support to patients with severe or complex diagnoses, ensuring seamless coordination and guiding them through the network targeted to minimize the cost and care delays while maintaining the quality.

10.

Act as the communication bridge between the patient, the treating physician, and the insurance company’s internal operations.