Medical Reviewer DubaiJobCenter Dubai
External Job Aggregation > Medical Reviewer

Search Jobs

Search

Medical Reviewer


DubaiJobCenter       |    Location:Dubai       |    Country:United Arab Emirates

As a member of Munich Re the MedNet Group is a leading Third-Party Administrator across the MEA region. We are currently seeking to hire a ?Medical Reviewer - Medical Care Unit?, who will be responsible to provide services related to medical evaluations / authorizations for (in-patient & outpatient) insured members / providers and handle calls / queries relating to calls / queries relating to pre-approvals.

Your Role:

  • Evaluate claims (Network & Direct), provide authorizations for insured members (in-patient & outpatient) and handle calls relating to medical cases efficiently.
  • Assess risk exposure of members in line with medical underwriting policies.
  • Manage queries from providers, Insurance Companies and insured members relating to pre-approval decisions, evaluation and administration.
  • Provide medical guidance to the Claims Department staff and assistance in ICD coding.
  • Deliver excellent customer service to Insurance Companies and insured members with a view of achieving maximum client satisfaction.
  • Client Management / attending hospital visits to investigate on claims in order to minimize fraud and abuse.
  • Compile data and prepare monthly statistical reports to monitor departmental performance and medical trends.

Your Profile:

  • Medical Degree (MBBS or equivalent) from a school recognized by the WHO.
  • 2-3 years of experience in Medical Claims Evaluation preferably from TPA / MSO organization in Insurance sector.
  • Certified Medical Coder (CPT/ ICD / DRGs).
  • Industry knowledge related to local healthcare services system.
  • Good interpersonal and negotiation skills
  • Excellent written and verbal communication skills
  • Strong leadership, planning and organizational skills
  • Analytical and problem-solving skills
  • Ability to handle stress.

Minimum Qualifications:

  • University degree in MBBS from a school recognized by the WHO
  • Certified Medical Coder (CPT/ ICD / DRGs).

Minimum Experience:

  • 2-3 years of experience in Medical Claims Evaluation preferably from TPA / MSO organization in Insurance sector.

Similar Jobs




Report / Flag this Job Ad


Tags :
Medical   Reviewer   Medical Dubai   Reviewer Dubai  

More Jobs

Senior Financial Crime Risk Investigator

Work Location: Toronto, Ontario, Canada Hours: 37.5 Line of Business: Financial Crime Risk M


As a candidate, you are encouraged to ask compensation related questions and have an open dialogue with your recruiter who can provide you more specific details for this role.

Job Description:

CUSTOMER
  • Conduct a variety of complex investigations, including AML, Sanctions/ABAC and Financial Crime
  • Apply sound methodologies to collect, preserve, and analyze evidence while staying current on global emerging risks and technology threats
  • Assess and prioritize files and investigate assigned cases ensuring proper protocols are in place and effectively applied
  • Work effectively with counterparts at other FI's, law enforcement, Non-Profits, and others in government within prescribed protocols to maximize opportunities for information sharing and to reduce TDBFG exposure
  • Conduct investigations in a professional and timely manner
  • Identify and communicate procedural weaknesses to businesses
  • Identify industry and typologies risk and trends for respective program areas and share knowledge with appropriate stakeholders.
  • Maintain and establish working relationships with internal partners (e.g., HR, Employment Standards and Legal etc.,) for investigative purposes
  • Apply sound methodologies to collect, preserve, and analyze digital evidence in accordance with investigative mandate.

SHAREHOLDER
  • Lead work stream by acting as a project lead for large or complex projects/initiatives in accordance with project management methodologies
  • Evaluate the effectiveness of processes/services and recommend/champion possible enhancements
  • Recommend improvements to escalation processes within the investigative unit and a feedback mechanism to relevant stakeholders.
  • Plan and deliver efficient and cost-effective processes that support and promote the implementation of programs
  • Conduct internal and external research projects; support the development/ delivery of presentations / communications to management or broader audience
  • Adhere to enterprise frameworks or methodologies that relate to activities for respective business area(s)
  • Monitor service, productivity and assess efficiency levels within own function and implement continuous process/performance improvements where opportunities exist
  • Consistently exercise discretion in managing correspondence, information and all matters of confidentiality; escalate issues where appropriate
  • Protect the interests of the organization - identify and manage risks, and ensure the prompt and thorough resolution of escalated non-standard, high-risk issues
  • Run analysis at the functional or enterprise level using results to draw conclusions, make recommendations, assess the effectiveness of programs/ policies/ practices
  • Keep abreast of emerging issues, trends, and evolving regulatory requirements and assess potential impacts
  • Maintain a culture of risk management and control, supported by effective processes in alignment with risk appetite

EMPLOYEE / TEAM
  • Participate fully as a member of the team, support a positive work environment that promotes service to the business, quality, innovation and teamwork and ensure timely communication of issues/ points of interest
  • Share industry knowledge for own area of expertise and participate in knowledge transfer within the team and business unit
  • Keep current on emerging trends/ developments and grow knowledge of the business, related tools and techniques
  • Participate in personal performance management and development activities, including cross training within own team
  • Keep others informed and up to date about the status / progress of projects and / or all relevant or useful information related to day-to-day activities
  • Contribute to team development of skills and capabilities through mentorship of others, by sharing knowledge and experiences and leveraging best practices.
  • Lead, motivate and develop relationships with internal and external business partners / stakeholders to develop productive working relationships.
  • Contribute to a fair, positive and equitable environment that supports a diverse workforce
  • Act as a brand ambassador for your business area/function and the bank, both internally and/or externally

BREADTH & DEPTH:
  • Investigates criminal cases ranging from simple to complex in nature
  • Sound knowledge of Bank products, systems, policies and procedures
  • Strong knowledge of criminal investigative techniques, related laws governing collection of evidence, court proceedings and financial/criminal trends
  • Manages programs/projects/ initiatives of low to moderate scope and complexity
  • Expert level professional role requiring in-depth knowledge/ expertise in own field of specialty and working knowledge of broader related areas
  • Integrates the broader organizational context into advice and solutions within own area
  • Understands the industry, competition and the factors that differentiate the organization
  • Impacts a range of functional programs across own and related teams
  • Interprets guidelines, standards, policies, and results of analysis to inform decision making at senior levels
  • Builds stakeholder alignment in leading projects and activities
  • Works independently as the senior technical lead and guides others within area of expertise
  • Identifies and leads problem resolution for complex issues at all levels
  • Generally, reports to a Group Manager/Senior Manager

EXPERIENCE AND / OR EDUCATION
  • Undergraduate degree or equivalent work experience
  • 5+ years experience

Who We Are:

TD is one of the world's leading global financial institutions and is the fifth largest bank in North America by branches/stores. Every day, we deliver legendary customer experiences to over 27 million households and businesses in Canada, the United States and around the world. More than 95,000 TD colleagues bring their skills, talent, and creativity to the Bank, those we serve, and the economies we support. We are guided by our vision to Be the Better Bank and our purpose to enrich the lives of our customers, communities and colleagues.

TD is deeply committed to being a leader in customer experience, that is why we believe that all colleagues, no matter where they work, are customer facing. As we build our business and deliver on our strategy, we are innovating to enhance the customer experience and build capabilities to shape the future of banking. Whether you've got years of banking experience or are just starting your career in financial services, we can help you realize your potential. Through regular leadership and development conversations to mentorship and training programs, we're here to support you towards your goals. As an organization, we keep growing - and so will you.

Our Total Rewards Package
Our Total Rewards package reflects the investments we make in our colleagues to help them and their families achieve their financial, physical, and mental well-being goals. Total Rewards at TD includes a base salary, variable compensation, and several other key plans such as health and well-being benefits, savings and retirement programs, paid time off, banking benefits and discounts, career development, and reward and recognition programs. Learn more

Additional Information:
We're delighted that you're considering building a career with TD. Through regular development conversations, training programs, and a competitive benefits plan, we're committed to providing the support our colleagues need to thrive both at work and at home.

Please be advised that this job opportunity is subject to provincial regulation for employment purposes. It is imperative to acknowledge that each province or territory within the jurisdiction of Canada may have its own set of regulations, requirements.

Colleague Development
If you're interested in a specific career path or are looking to build certain skills, we want to help you succeed. You'll have regular career, development, and performance conversations with your manager, as well as access to an online learning platform and a variety of mentoring programs to help you unlock future opportunities. Whether you have a passion for helping customers and want to expand your experience, or you want to coach and inspire your colleagues, there are many different career paths within our organization at TD - and we're committed to helping you identify opportunities that support your goals.

Training & Onboarding
We will provide training and onboarding sessions to ensure that you've got everything you need to succeed in your new role.

Interview Process
We'll reach out to candidates of interest to schedule an interview. We do our best to communicate outcomes to all applicants by email or phone call.

Accommodation
Your accessibility is important to us. Please let us know if you'd like accommodations (including accessible meeting rooms, captioning for virtual interviews, etc.) to help us remove barriers so that you can participate throughout the interview process.

We look forward to hearing from you!

Language Requirement (Quebec only):
Sans Objet'>

Customer Experience Associate

Work Location: Chilliwack, British Columbia, Canada Hours: 15 Line of Business: Personal & C


As a candidate, you are encouraged to ask compensation related questions and have an open dialogue with your recruiter who can provide you more specific details for this role.

Job Description:

Department Overview:

At TD Canada Trust, we are the frontline of TD Bank. We strive to build deep and long-lasting relationships with our customers by performing a broad range of customer service transactions and providing information and advice on services, products, and solutions to existing or prospective TD customers. At the branch, we understand customer needs and identify opportunities to promote products and services to refer customers to the appropriate team member or internal Bank partner, while ensuring a positive customer experience.

Join TD Canada Trust and Think like a customer, Act like an Owner, Innovate with purpose and Execute with Speed and Impact.

Job Description:

Can you bring your charming self to work and make customer interactions delightful one? Can you process financial transactions accurately and get a sense of achievement by providing excellent customer experience? If so then, take the next step to your future today and apply for the position of a Customer Experience Associate. We are expecting an all-around champion who can understand customer needs and advise best suited banking solutions for a positive customer experience.

In this role, you will:

• Process financial transactions like deposits, withdrawals, and bill payments as per standardized operating procedures, industry regulations and TD's Code of Conduct and Ethics

• Understand and determine customer needs to recommend solutions specific to those needs while exercising discretion in confidential matters

• Respond and resolve customers' concerns using standard procedures and escalating non-standard activities, as necessary

• Achieve assigned goals and business objectives by promoting banking solutions and completing business processes in a timely and accurate manner

• Connect personally with customers to advise them appropriately and clearly on banking solutions and processes

• Help build a positive, diverse and equitable work environment by promoting team effectiveness as well as participating in personal performance development

• Assist the team by respecting coworkers, staying dedicated, and keeping everyone up-to-date on the status of routine activities

• Deliver quality customer experiences and recommend operational improvements where opportunity exists to improve and achieve operational excellence

Job Requirements:

• High School diploma and/or 1+ years of relevant experience • Undergraduate degree or equivalent is an asset. • Strong administration, organizational, planning and time management skills to work in a fast-paced environment. • Hands on knowledge of using MS Office (Word, Excel, and Outlook) and internet. • A go-getter who can exercise initiative and be accurate and detail oriented to handle several tasks and changing priorities. • A dynamic communicator with established customer experience skills who can connect, both verbally and in writing, with different people in a calm, courteous, and effective manner

Who We Are:

TD is one of the world's leading global financial institutions and is the fifth largest bank in North America by branches/stores. Every day, we deliver legendary customer experiences to over 27 million households and businesses in Canada, the United States and around the world. More than 95,000 TD colleagues bring their skills, talent, and creativity to the Bank, those we serve, and the economies we support. We are guided by our vision to Be the Better Bank and our purpose to enrich the lives of our customers, communities and colleagues.

TD is deeply committed to being a leader in customer experience, that is why we believe that all colleagues, no matter where they work, are customer facing. As we build our business and deliver on our strategy, we are innovating to enhance the customer experience and build capabilities to shape the future of banking. Whether you've got years of banking experience or are just starting your career in financial services, we can help you realize your potential. Through regular leadership and development conversations to mentorship and training programs, we're here to support you towards your goals. As an organization, we keep growing - and so will you.

Our Total Rewards Package
Our Total Rewards package reflects the investments we make in our colleagues to help them and their families achieve their financial, physical, and mental well-being goals. Total Rewards at TD includes a base salary, variable compensation, and several other key plans such as health and well-being benefits, savings and retirement programs, paid time off, banking benefits and discounts, career development, and reward and recognition programs. Learn more

Additional Information:
We're delighted that you're considering building a career with TD. Through regular development conversations, training programs, and a competitive benefits plan, we're committed to providing the support our colleagues need to thrive both at work and at home.

Please be advised that this job opportunity is subject to provincial regulation for employment purposes. It is imperative to acknowledge that each province or territory within the jurisdiction of Canada may have its own set of regulations, requirements.

Colleague Development
If you're interested in a specific career path or are looking to build certain skills, we want to help you succeed. You'll have regular career, development, and performance conversations with your manager, as well as access to an online learning platform and a variety of mentoring programs to help you unlock future opportunities. Whether you have a passion for helping customers and want to expand your experience, or you want to coach and inspire your colleagues, there are many different career paths within our organization at TD - and we're committed to helping you identify opportunities that support your goals.

Training & Onboarding
We will provide training and onboarding sessions to ensure that you've got everything you need to succeed in your new role.

Interview Process
We'll reach out to candidates of interest to schedule an interview. We do our best to communicate outcomes to all applicants by email or phone call.

Accommodation
Your accessibility is important to us. Please let us know if you'd like accommodations (including accessible meeting rooms, captioning for virtual interviews, etc.) to help us remove barriers so that you can participate throughout the interview process.

We look forward to hearing from you!

Language Requirement (Quebec only):
Sans Objet'>

Nurse Practitioner (np)

Position Summary The Opportunity Northern Health is seeking four Nurse Practitioners to join the i

-Eligible for registration as a Nurse Practitioner with British Columbia College of Nurses and Midwives (BCCNM).

Knowledge, Skills and Abilities
-Ability to communicate and collaborate with patients/clients/residents and families about health findings, diagnosis, treatment, self-care and prognosis.
-Ability to collaborate, consult with and formally refer patients/clients/residents to physicians and other health professionals when appropriate.
-Ability to critically assess and evaluate health research literature to determine best practices; ability to introduce education and evidence-based research.
-Ability to assess and recognize population health trends; ability to plan and implement strategies for population-based prevention and health promotion.
-Ability to implement and evaluate planned change.
-Ability to supervise others and evaluate the care they deliver.
-Ability to lead a team and work within a team.
-Ability to self-direct, interact, and adapt effectively with other professionals in complex, dynamic situations.
-Ability to transfer knowledge, teach, coach and mentor others.
-Ability to identify and respond appropriately to legal and ethical issues that may arise in patient/resident/client care.
-Ability to self-assess performance and assume responsibility and accountability for own professional development, educational or consultative assistance when appropriate.'>

Nurse Practitioner (np)

Position Summary The Opportunity Northern Health is seeking four Nurse Practitioners to join the i

-Eligible for registration as a Nurse Practitioner with British Columbia College of Nurses and Midwives (BCCNM).

Knowledge, Skills and Abilities
-Ability to communicate and collaborate with patients/clients/residents and families about health findings, diagnosis, treatment, self-care and prognosis.
-Ability to collaborate, consult with and formally refer patients/clients/residents to physicians and other health professionals when appropriate.
-Ability to critically assess and evaluate health research literature to determine best practices; ability to introduce education and evidence-based research.
-Ability to assess and recognize population health trends; ability to plan and implement strategies for population-based prevention and health promotion.
-Ability to implement and evaluate planned change.
-Ability to supervise others and evaluate the care they deliver.
-Ability to lead a team and work within a team.
-Ability to self-direct, interact, and adapt effectively with other professionals in complex, dynamic situations.
-Ability to transfer knowledge, teach, coach and mentor others.
-Ability to identify and respond appropriately to legal and ethical issues that may arise in patient/resident/client care.
-Ability to self-assess performance and assume responsibility and accountability for own professional development, educational or consultative assistance when appropriate.'>