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Preferred Candidate


Years of Experience:
2 - 5 yrs
Age Group:
27 - 35 yrs
Nationality:
Arab Nationals
Gender:
Male
IT Knowledge:
Applications-Office
Language:
English: Fluent
Arabic: Fluent

Ref.No: 4334 Date of Posting: 04-Apr-2017
Medical Officers - Insurance Medical Claims Bookmark and Share
Confidential Company
Job Description
A leading Kuwaiti Healthcare Services Company is looking for Medical officers (to review Insurance Medical Claims) as per the following details:

1- Main Requirement:
• MBBS from a reputable university.
• 2+ years of medical practitioner’s experience as medical doctor
• Excellent communication skills and bilingual candidate ( Proficient in Arabic and English).
• Must be Male due to working on shift schedule
• Sound decision-making abilities and able to take technical and financial decisions on complicated and high-cost medical insurance claims
• Must have a flair for customer services
• Experience with Call centers and helpdesk is a plus.
• Able to supervise / Mentor a team of non-doctors

2- Responsibilities and duties
• Research and follow up on Medical Treatment patterns and conduct utilization reviews for: Beneficiaries (policy holders) & Medical Network providers, Quality control by:
 Assess day-care and in-patient cases as per medical justification and policy coverage.
 Issuing day-care and in-patient cases for medically justified cases in line with the policy.
 Escalate and confirm grey-area cases. Confirming of exclusions of borderline cases OP/IP.
 Assists CC officers and supervisors in claims adjudication cases as needed.
 Sending request of confirmation and notification to corresponding payers as needed.
• Responding to payer's queries in relation to day-care and In-patient cases.
• Responding to the payers request for advice on coverage of cases.
• Conformity of assessment for the prescribed tests/medications/investigations/clinical
procedures.
• Contacting provider for queries and clarifications.
• Doing clinical discussion directly with the network's doctor as needed.
• Seeking verbal clinical opinion from Network's doctor as needed.
• Assisting the Managers as needed.
• Any additional as may be assigned
Degree Specifications
Graduate - BSc in Medical Science
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