Role Overview

We are looking for a UAEN Doctor of Medicine to join our Health Insurance Medical Team. The role focuses on medical review, clinical assessment, and decision-making related to health insurance claims, pre-authorizations, and medical policies. The physician will ensure medical necessity, quality of care, and compliance with regulatory and payer guidelines.

This is a non-clinical, office-based medical role requiring strong analytical and decision-making skills.

Key Responsibilities

Review medical claims and pre-authorization requests for medical necessity and appropriateness
Assess treatment plans, diagnostic tests, and procedures against clinical guidelines
Provide medical opinions on complex or high-cost cases
Ensure compliance with DOH/DHA/MOH and insurance policy regulations
Support fraud, waste, and abuse detection through medical review
Liaise with healthcare providers to clarify medical information when required
Contribute to medical policy development and updates
Participate in audits, case discussions, and quality assurance initiatives

Qualifications & Requirements

UAEN
MBBS or equivalent medical degree
Understanding of clinical guidelines and evidence-based medicine
Strong analytical and documentation skills
Proficiency in medical terminology and insurance concepts

The National Insurance Company – Daman jobs

Doctor of Medicine (UAEN) | United Arab Emirates