Senior Medical Officer

Job Description

Your Job

• Provide overall guidance about the medical cases review, evaluation and authorization activities ensuring compliance with established policy guidelines.
• Revise & confirm application of TOB, PIC Exclusion List & policy amendments with concerned departments.
• Support in Training of New MCC members regarding P&P, medical guidelines and chronic cycle.
• Respond to all clients’ queries though Fax, email, and phone calls etc.
• Responsible for approval and entry of all Chronic modules (New & Renewed policies), support in communication with account management Team regarding approved & rejected cases per policy.
• Review New monthly chronic Incidents regarding Technical (C.F, duplication, ICD) & Medical Guidelines (Medical assessment).
• Request Re-consultations for specific cases (not medically justified, Irregular dispensing manner), communicate and follow-up the cases that require Re-consultations with the account management Team according to agreed deadlines.
• Revise and request exceptions renewal per policy & per members with the account management team.
• Review medical trends, identify fraudulent cases and notify the medical team leader to minimize abuse of medical insurance.

Your Profile

• Bachelor’s degree of Pharmacy/ Dentistry.
• 3-5 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.