Case Manager/Medical Advisor (MBBS) - Insurance TPA
Job Fit Check
Base Career helps you apply smarter for this job.
Key skills for this role
About the Role
Dubai Insurance TPA seeks a Case Manager/Medical Advisor with an MBBS degree to evaluate and coordinate treatment plans for complex inpatient cases. The role involves liaising with healthcare providers, conducting on-site hospital visits, and ensuring cost-effective care.
Key Skills for This Role
Responsibilities
- Conduct thorough clinical, policy, and coding assessments of complex inpatient cases
- Liaise with treating physicians, hospital insurance departments, and payers to ensure appropriate care and cost containment
- Perform on site hospital visits when necessary to review medical records, discuss treatment plans, and negotiate discounts
- Ensure accurate DRG coding and severity level classification in line with UAE and international guidelines
- Coordinate second medical opinions and referrals to low cost or home country facilities when appropriate
- Draft detailed case summaries and recommendations for payer approval
- Maintain accurate documentation and reporting of all case management activities
- Monitor and report cost savings achieved through negotiated discounts, DRG adjustments, and alternative treatment plans
Requirements
- Bachelor’s degree in medicine MBBS/ MD (mandatory)
- Minimum 3–5 years of experience in Health Insurance Sector
- Strong knowledge of DRG coding, UAE billing guidelines, and insurance policy interpretation
Full Job Posting
Job Purpose
- The Case Manager plays a critical role in evaluating, coordinating, and facilitating appropriate treatment plans in collaboration with healthcare providers, payers, and internal teams, while ensuring compliance with policy terms and clinical guidelines.
- To ensure the delivery of high quality, cost effective inpatient care by managing complex and high cost medical cases.
Responsibilities and Duties
- Conduct thorough clinical, policy, and coding assessments of complex inpatient cases.
- Identify and manage eligible cases such as high cost admissions, prolonged hospital stays, complications, and disputed claims.
- Liaise with treating physicians, hospital insurance departments, and payers to ensure appropriate care and cost containment.
- Perform on site hospital visits when necessary to review medical records, discuss treatment plans, and negotiate discounts.
- Ensure accurate DRG coding and severity level classification in line with UAE and international guidelines.
- Coordinate second medical opinions and referrals to low cost or home country facilities when appropriate.
- Draft detailed case summaries and recommendations for payer approval.
- Maintain accurate documentation and reporting of all case management activities.
- Collaborate with internal teams to resolve ambiguities and ensure consistent decision making.
- Monitor and report cost savings achieved through negotiated discounts, DRG adjustments, and alternative treatment plans.
Knowledge, Skills, and Experience
- Bachelor’s degree in medicine MBBS/ MD (mandatory).
- Certification in Health Insurance, Coding, Audit or Case Management is an advantage.
- Minimum 3–5 years of experience in Health Insurance Sector.
- Strong knowledge of DRG coding, UAE billing guidelines, and insurance policy interpretation.
Pay
- Pay: AED14,000.00 AED16,000.00 per month
Work Location
- Work Location: In person
Apply for this job in 1 click
Skip the repetitive application forms
Install the Base Career Chrome Extension and autofill job applications across major job boards with your profile.
Trusted by over 500,000 job seekers on Base Career
More from this employer
More jobs at Dubai Insurance TPA
Data Engineer - Insurance/TPA experience
Dubai, UAE
Dubai Insurance TPA is looking for a Data Engineer to develop, implement, and maintain data management processes and infrastructure. The role requires experience in database design, data security, and managing complex bu
Database Administrator - Insurance/TPA
Dubai, UAE
Dubai Insurance TPA seeks a Database Administrator to manage Oracle and SQL Server databases. The role involves installation, configuration, monitoring, backup, recovery, and security. Requires 3+ years experience, Oracl
Mobile App Developer - Insurance/TPA exp
Dubai, UAE
Dubai Insurance TPA is looking for a Mobile App Developer with at least 3 years of experience in mobile application design and development. The role involves gathering user requirements, writing clean code using Swift, K
Wellness Coach - (Personal Trainer) with corporate and Insurance experience - Female Arabic speaker
Dubai, UAE
Dubai Insurance TPA seeks a Wellness Coach/Personal Trainer to plan and supervise fitness/wellness programs for clients and staff. Requires a Bachelor's degree in health or physical education, 2 years of experience, and
Senior Installation Associate -Account Installation (Insurance TPA)
Dubai, UAE
Dubai Insurance TPA seeks a Senior Installation Associate to manage complex account installations and renewals for large corporate and SME accounts. The role involves defining onboarding plans, tracking milestones, and c
Wellness Coordinator - with Insurance and TPA experience
Dubai Silicon Oasis, UAE
We are seeking a passionate Wellness Coordinator to join our team in Dubai Silicon Oasis. The role involves planning and executing wellness activities for employees and designing wellness programs for external clients. C
Wellness Coordinator
Dubai Silicon Oasis, UAE
Dubai Insurance TPA is seeking a Wellness Coaching Analyst to design and manage wellness programs for both internal employees and external clients. The role involves conducting assessments, coordinating wellness activiti
Manager - Claims & Pre-Authorization
Dubai Silicon Oasis, UAE
Dubai Insurance TPA is seeking a Manager to lead Pre-Authorization and Claims Operations. You will oversee SLA performance, regulatory compliance, quality management, and team development. The ideal candidate has 7-8 yea
Data Engineer - Insurance/TPA experience
Dubai, UAE
Database Administrator - Insurance/TPA
Dubai, UAE
Mobile App Developer - Insurance/TPA exp
Dubai, UAE
Wellness Coach - (Personal Trainer) with corporate and Insurance experience - Female Arabic speaker
Dubai, UAE
Senior Installation Associate -Account Installation (Insurance TPA)
Dubai, UAE
Wellness Coordinator - with Insurance and TPA experience
Dubai Silicon Oasis, UAE
Wellness Coordinator
Dubai Silicon Oasis, UAE
Manager - Claims & Pre-Authorization
Dubai Silicon Oasis, UAE