Medical Officer – Outpatient Precertification is responsible for managing the Outpatient Precertification claims while ensuring that departmental goals, timeline of activities, and compliance measures are met.
•Precertification team is functional on 24/7 basis. Therefore, the Medical Officer will work on a flexible shift basis as per the schedule provided by the Team Leader.
•Adjudicates - outpatient medical claims by evaluating each case from both the technical and clinical perspectives, ensuring all decisions comply with policy terms and conditions and are delivered within the stipulated turnaround time and quality standards.
•Performs a comprehensive review of outpatient documentation, including consultation notes, diagnostic reports, laboratory results, radiology findings, prescriptions, treatment plans, and follow‑up notes to validate medical necessity and appropriateness of care.
•Assesses the necessity and justification of proposed treatment plans, ensuring alignment with evidence‑based guidelines and outpatient benefit structures
•Requests additional medical documentation or identifies missing information essential for accurate decision‑making, coordinating with providers when clarification is required
•Conducts utilization review for outpatient services, including but not limited to evaluation of billed items, non‑covered services, overutilization patterns, and appropriateness of investigations or procedures.
•Performing review of claims as per CPT and ICD coding guidelines in line with insurance regulators (DHA,DOH/HAAD,MOH).
•Adheres to cost‑containment protocols by ensuring outpatient services are medically justified, appropriately billed, and aligned with network rules and negotiated tariffs
•Maintains daily productivity and service level targets, ensuring timely adjudication and consistent workflow management
•AI READINESS Work effectively in an environment shaped by artificial intelligence (AI), machine learning, data, analytics and cloud-based tools, using insights responsibly with our standards of data governance, security and ethical use.
What you bring
•Bachelor’s of Pharmacy / Dentistry / Medicine / Nursing / Physiotherapist / Paramedics
•01-02 years of Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus) OR Entry Level
•Physically fit to carry out duties.
•Certified Medical Coder [Preferable]
•Legally permitted to work in the country of operations.
•Physically fit to carry out duties.
•Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.
How we hire
Agency Statement Allianz Partners does not accept unsolicited CV’s or approaches from agencies. We only work with partners on our approved supplier list, under contract. Any unsolicited submission will not be considered
Key benefits/What we offer
Allianz Partners is a world leader in B2B2C insurance and assistance, offering global solutions that span international health and life, travel insurance, automotive and assistance. Customer driven, our innovative experts are redefining insurance services by delivering future-ready, high-tech high-touch products and solutions that go beyond traditional insurance. Our products are embedded seamlessly into our partners’ businesses or sold directly to customers, and are available through four commercial brands: Allianz Assistance, Allianz Automotive, Allianz Travel and Allianz Care.
At Allianz Partners, Artificial Intelligence (AI) is transforming service delivery and innovation. By leveraging Business Intelligence and Data Analytics, we enhance strategic decision-making and customer experiences. Our commitment to Ethical AI ensures responsible deployment, maintaining data integrity and trust. Conversational AI improves communication, while Emerging Technologies and Generative AI drive industry leadership and new opportunities. With robust Information Security Management, we protect sensitive information, ensuring compliance and security. Embrace the future of AI with Allianz Partners, where possibilities become realities.