Medical Board Consultant / Medical Approval Officer - -Dubai
Dubai -Medical Board Consultant / Medical Approval Officer (1900069Q) PRIMARY LOCATION : UNITED ARAB EMIRATES-UNITED ARAB EMIRATES-Dubai - ORGANIZATION : AXA Gulf CONTRACT TYPE : Regular SHIFT : Rotating SCHEDULE : Full-time DESCRIPTION Job Purpose: To scrutinize in a professional manner medical claims (both reimbursement and direct billing) and to provide prior approval for medical treatment. In carrying out this role the jobholder will liaise and negotiate with the medical providers to ensure the validity of the treatment as per the insurance policy terms and conditions and to ensure that prices are in line with those agreed for Network providers or remain “reasonable and customary” for non Network providers. The role is responsible for effective communication with the Insured Members in order to explain the covers and answer any specific question related to a given claim. Main Accountability: Handle relations with the Medical Providers which includes negotiating all the discounts, studying all the price lists, handling reconciliations and visit the Medical Providers on a regular basis; Analyse prior-approval requests, negotiate the cases with the medial providers, approve the cases when agreement is reached and enter the claim into AXA Insurance E.C. IT system; Supervise In-patient claims (this supervision includes visits to the patients during their hospitalization); Advise on Medical Basics and Practice; Assist Medical Claims Administrators in processing claims; Validate all medical claims in AXA Insurance E.C.’ s IT system; Communicate with Insured Members on their claims and on any request coming from an Insured Member Drive training and information seminars on AXA Insurance E.C. medical products directed toward clients, prospects and internal Sales forces. Ensure that all medical information is kept confidential. QUALIFICATIONS Minimum Criteria / Requirement: Sound knowledge of all medical insurance policies, billing policies and pricing / fee arrangements. Expert knowledge of medical conditions, treatments and procedures in order to guide claimants and challenge medical practitioners and healthcare providers. Basic understanding of competitors and their products. Completed Tertiary education in Medical degree (Medicine). At least 3 years experience in related field. ABOUT AXA Would you like to wake up every day driven and inspired by our noble mission and to work together as one global team to empower people to live a better life? Here at AXA we strive to lead the transformation of our industry. We are looking for talented individuals who come from varied backgrounds, think differently and want to be part of this exciting transformation by challenging the status quo so we can push AXA - a leading global brand and one of the most innovative companies in our industry - onto even greater things. In a fast-evolving world and with a presence in 64 countries, our 166,000 employees and exclusive distributors anticipate change to offer services and solutions tailored to the current and future needs of our 103 million customers. With a workforce of over 1,000 employees, 44 branches & retail shops region-wide, more than 1 million customers and 2015 gross written premium of over US$ 963 million, AXA is one of the largest international player in the GCC. Present in the region for more than 65 years, AXA in the Gulf offers a wide range of insurance products and services for corporate, SME and individual customers. Our business is to protect people over the long term. We emphasis on designing reliable solutions to meet the needs of our customers, manage risks in a professional way, treat our partners fairly, develop a work environment built on strong values, relationship and trust We also believe that we have a role to play in protecting the environment, supporting the communities in which we operate, and more broadly in helping to create stronger and more sustainable societies. This is part of creating a sustainable, long-term business, and becoming the preferred company for our customers, employees, and other stakeholders. AXA Gulf has been awarded General Insurance Company of the Year for 2nd consecutive year and Health Insurance Company of the Year at the 2015 Middle East Insurance Industry Awards (MIIA), Insurer of the Year and Personal Lines insurer in 2016 at the MENA Insurance Awards and Best Motor Insurance Product by the Banker Middle East in both UAE & KSA. As part of AXA’s corporate responsibility and its commitment to building better understanding about the health risks faced by individuals and the society, the company achieved a new Guinness world record for the most blood cholesterol readings in 8 hours at a single venue. WHAT WE OFFER We are investing significantly in the Gulf region and we recognise the important role employees have in the success of our business. We offer excellent opportunities for motivated and talented candidates whether at entry level or at c-suite level. We value diversity and we encourage applicants of various backgrounds and nationalities to join our team.
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