Job Description

About the job

MedNet Egypt is one of the leading managed care service organizations that caters to healthcare needs. We are looking for a skilled Medical Officer who will evaluate medical authorizations and provide decisions for outpatient services and will assist our service providers with their inquiries.

Your Job

• Review approval requests and provide decision based on policy guidelines and customer needs.
• Review monthly chronic medication requests and provide decision based on policy guidelines and medical justifications.
• Monitor utilization rate and early detection of fraud and control.
• Respond to inbound phone calls and generate outbound calls to confirm high response rate % according to preset KPIs and SLAs.
• Respond to all clients’ queries though Online, email, etc. for all out-patient queries.
• Actively solicit and gather customer feedbacks in order to improve service levels. Use multiple channels including (but not limited to) periodic customer satisfaction surveys and personal interactions.
• Assess risk exposure of members in line with medical underwriting policies.
• Manage queries from providers, Insurance Companies and insured members relating to call center activities and approval.
• Provide medical guidance to the Claims Department staff and assistance in ICD coding in coordination with Network Department.
• Responding to all international accounts’ requests and all inquiries from insurance companies.
• Deliver excellent customer services to Insurance Companies and insured members with view of achieving maximum client satisfaction.
• Compile data and prepare statistical reports on daily, weekly & monthly basis to monitor department al performance and medical trends.
• Medical Updating of the Medical File related to insured members regarding their investigations results like MRI, CT scan, etc….
• Updating Monthly chronic medication reports.

Your Profile

• Bachelor’s degree of Pharmacy.
• 0-3 years of experience in their educational field.
• Previous experience in the insurance field is a plus.
• Fluent English language
• Excellent verbal and written communication skills
• Time management skills
• Analytical and problem-solving skills
• Ability to handle stress.
• Decision Maker.