Medical Claims Analyst

The Medical Claims Analyst provides specialized support to the Munich Re Health Team across the Middle East Region, conducting comprehensive analysis of health insurance claims through both prospective and retrospective review methodologies. This position is essential to upholding clinical quality standards, enhancing operational cost-efficiency, and maintaining the integrity of billing and claims processes across all claim categories.

Your role:

• Monitor and review pre-approvals in coordination with the insurance team, ensuring timely and clinically appropriate feedback on case management interventions.
• Conduct comprehensive coding reviews on all inpatient approvals to ensure compliance with ICD, CPT, and DRG standards.
• Implement evidence-based cost containment strategies, including provider negotiations, second medical opinions, and home country referral facilitation in collaboration with the insurance team.
• Periodically analyze outpatient claims to identify utilization trends, provider performance patterns, and document suspected fraud, waste, and abuse for escalation.
• Establish and maintain approval thresholds for different Third-Party Administrators (TPAs) in collaboration with insurance partners to ensure alignment with clinical quality and cost efficiency objectives.
• Provide clinical expertise and assistance in health insurance medical underwriting processes as required
• Review medical evidence and recommend appropriate coverage determinations
• Support risk assessment activities in collaboration with the underwriting team

Your Profile:

• Bachelor's degree in Medicine (MD/MBBS) or equivalent medical qualification
• Current Certification in Medical Coding and Billing (e.g., AAPC, ICD-10, or equivalent regional certification)
• Minimum 3 years of hands-on experience in health insurance claims management in the UAE market
• Additional insurance qualifications (e.g., AICL, RPA) are highly desirable.
• Excellent problem-solving and time management skills
• Good interpersonal and communicational skills
• Team player, motivated, dependable, and open-minded
• Assertive, reliable and business-minded with good negotiation skills.

*Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunities employer.