internal medicine physician

MedNet Egypt is one of the leading managed care service organisations that cater to healthcare needs. We are looking for a skilled Sr. Reviewer who will be responsible for evaluating medical authorisations and provide decisions for inpatient services mainly through online, faxes, emails and phone calls and will assist our service providers with their inquiries.

Your Job

Evaluate Network & Direct claims, provide authorisations for insured members (Inpatient) and handle queries relating to medical cases efficiently.

• Medical evaluation for in-hospital cases in respect of medical necessity and appropriateness.
• Respond to all clients queries though email, etc. for all in-patient queries to pre-set KPIs and SLAs.
• Primary Medical auditing of all inpatient claims received from the claims department on daily basis.
• Compile data and prepare statistical reports on daily, weekly & monthly basis to monitor department's performance and medical trends.
• Manage queries from providers, Insurance Companies and insured members relating to call centre activities and approval.
• Responding to all international accounts’ inpatient 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's performance and medical trends.

Your Profile

• Bachelor’s degree in medicine.
• Two to four years' experience in medical approval and/or claims activities in the insurance industry or a TPA/MSO
• Computer literacy (MS Office, Excel, PowerPoint) and Database management skills
• Time management skills.
• Good command in English
• Good interpersonal and negotiation skills
• Excellent written and verbal communication skills
• Strong leadership, planning and organisational skills
• Analytical and problem-solving skills and Decision Making skills.