Job Description

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 mainly through online, faxes, emails and phone calls and will assist our service providers with their inquiries.

Your Job

• Review approval requests and provide decision based on policy guidelines and customer needs within set turnaround time and accurately check the service description codes and benefit matching stated on the prior authorization requests, according to accepted medical coding rules, medical guidelines and policy’s schedule of benefits..
• Achieve the proper capturing of the data on the system with a focus on accuracy, efficiency, ensuring that business decisions and processes are applied and documented in a professional way.
• 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 Fax, email, phone calls etc.
• Assess risk exposure of members in line with medical underwriting policies.
• Perform night shift duty to sustain any issues and queries related to Authorization department
• Deliver excellent customer service to Insurance Companies and insured members with view of achieving maximum client satisfaction.

Your Profile

• Bachelor’s degree of Pharmacy.
• 0-2 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.