Medical Officer - MBBS Doctor - TPA

Job Summary

We are seeking a qualified and DHA/DOH/MOH licensed MBBS Medical Officer with proven experience in Insurance / TPA operations to review medical claims, provide clinical assessments, and ensure compliance with regulatory and insurance guidelines. The ideal candidate should have strong knowledge of UAE healthcare regulations and insurance protocols.

Key Responsibilities

• Review and assess medical claims, pre-authorizations, and reimbursement requests.
• Evaluate medical necessity and treatment appropriateness in line with policy terms.
• Approve or decline claims based on clinical justification and insurance guidelines.
• Liaise with healthcare providers, hospitals, and clinics regarding claim clarifications.
• Provide medical opinions and recommendations to the claims team.
• Ensure compliance with DHA / DOH / MOH regulations and company policies.
• Support audits, quality assurance, and fraud detection processes.
• Maintain accurate documentation and records of claim decisions.
• Participate in medical case discussions and internal training sessions.

Qualifications & Requirements

• MBBS degree from a recognized institution.
• Valid UAE medical license (DHA / DOH / MOH).
• Minimum 2–5 years of clinical experience.
• At least 1–3 years of experience in Insurance / TPA operations.
• Strong understanding of medical coding, billing, and claims adjudication.
• Knowledge of UAE insurance regulations and healthcare compliance standards.
• Strong analytical and decision-making skills.
• Excellent communication skills (written & verbal).

Preferred Skills

• Experience in pre-authorization and medical claims review.
• Familiarity with ICD, CPT coding systems.
• Experience handling high-volume claims processing.
• Ability to work under deadlines with high accuracy.

Competencies

• Attention to detail
• Ethical decision-making
• Confidentiality & integrity
• Team collaboration
• Problem-solving ability

Job Types: Full-time, Permanent

Pay: AED8,000.00 - AED10,000.00 per month