Doctor of Medicine (UAEN)

Role Overview

We are looking for a UAEN Doctor of Medicine to join our Health Insurance Medical Team. The role focuses on medical review, clinical assessment, and decision-making related to health insurance claims, pre-authorizations, and medical policies. The physician will ensure medical necessity, quality of care, and compliance with regulatory and payer guidelines.

This is a non-clinical, office-based medical role requiring strong analytical and decision-making skills.

Key Responsibilities

• Review medical claims and pre-authorization requests for medical necessity and appropriateness
• Assess treatment plans, diagnostic tests, and procedures against clinical guidelines
• Provide medical opinions on complex or high-cost cases
• Ensure compliance with DOH/DHA/MOH and insurance policy regulations
• Support fraud, waste, and abuse detection through medical review
• Liaise with healthcare providers to clarify medical information when required
• Contribute to medical policy development and updates
• Participate in audits, case discussions, and quality assurance initiatives

Qualifications & Requirements

• UAEN
• MBBS or equivalent medical degree
• Understanding of clinical guidelines and evidence-based medicine
• Strong analytical and documentation skills
• Proficiency in medical terminology and insurance concepts