Medical Claims Officer - Roving
Job Level:
Entry Level
Location:
Riyadh, SA
Area of Expertise:
Audit
Unit:
Allianz Partners
Employing Entity:
Nextcare Saudi Arabia
Job Type:
Full-Time
Remote Job:
100% on-site
Employment Type:
Permanent
ID:
84600
Position Cluster:
Summary
Roving doctor is responsible for continuous daily monitoring and supervision of in-patient cases within his region as well as regular enhancement of the presence of Nextcare in healthcare providers. Manage cases with medical and technical due diligence, assuring sound and accurate medical decision is taken with utmost cost efficiency.
Main Tasks
•Daily extraction of Inpatient report for cases within assigned region and daily assessment and evaluation of cases.
•Investigate inpatient cases in order to get the correct picture with justification including management plan and to follow thoroughly serious cases even though already roved.
•Coordinate with site-delegates to manage and prepare daily inpatient report.
•Provide a unified and standardized roving reports on daily basis. Consolidated weekly reports for visited in-patient cases and saving achieved are provided by the end of each week and by the end of each month.
•Coordinate for Cost Containment and savings measures including special discounts, transfer to low class/cost provider and case transfer to home country.
•In case of suspicious activities, data shall be collected and relevant function shall be informed for their necessary actions. E.g. FWA, Pre Cert .. etc
•To approve urgently required services/ procedures according to Standard Medical Practice and Evidence Based Medicine.
•Follow medical guidelines, practices and regulator ( IA ) instructions.
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Minimum Requirements:
•Bachelor of Medicine and Bachelor of Surgery MBBS
•3+ years of experience in a mid-to-large sized organization in the similar role.
•SCFHS
•Typing and communication skills in English & Arabic.
•Clean and valid Driving license.
•Physically fit to carry out duties
•Legally permitted to work in the country of operations.
•Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.
