Doctor of Medicine
Job Description
We are looking for a UAEN Doctor of Medicine to join our Health Insurance Medical Team. The role focuses on medical review, clinical assessment, and decision-making related to health insurance claims, pre-authorizations, and medical policies. The physician will ensure medical necessity, quality of care, and compliance with regulatory and payer guidelines.
This is a non-clinical, office-based medical role requiring strong analytical and decision-making skills.
Key Responsibilities
- Review medical claims and pre-authorization requests for medical necessity and appropriateness
- Assess treatment plans, diagnostic tests, and procedures against clinical guidelines
- Provide medical opinions on complex or high-cost cases
- Ensure compliance with DOH/DHA/MOH and insurance policy regulations
- Support fraud, waste, and abuse detection through medical review
- Liaise with healthcare providers to clarify medical information when required
- Contribute to medical policy development and updates
- Participate in audits, case discussions, and quality assurance initiatives
Qualifications & Requirements
- UAEN
- MBBS or equivalent medical degree
- Understanding of clinical guidelines and evidence-based medicine
- Strong analytical and documentation skills
- Proficiency in medical terminology and insurance concepts
