Medical Liaison Coordinator

Country United Arab Emirates Working Schedule Full-Time Work Arrangement Hybrid Relocation Assistance Available No Posted Date 17-May-2024 Job ID 2685 Description and Requirements

JOB PURPOSE:

Liaising and servicing HealthCare Providers/insured members by ensuring a smooth Medical Preauthorization process.

DESCRIPTION:

• Responsible for reviewing, analysing & authorising services in line with benefits adjudication as per medical and coding guidelines. This includes diagnosis, prescription of medicine, minor operations, inpatient hospital confinement, outpatient surgeries, outpatient laboratory tests, physiotherapy, MRI/ CT scan tests and different treatments for injuries, diseases and other ailments. Authorizing Medical / Surgical Outpatient, Inpatient Cases for MetLife insured members by Network Hospitals & Clinics. This include validation of all applicable inpatient and daycase DRG
• Identifying cases for Case Management of MetLife insured members who are confined to a hospital for medical/ surgical management and sending Case Alerts to the Case Management Unit
• Participating in Health Wellness Campaigns like I ACT for Diabetic MetLife insured members
• Coordinating with MetLife insured members & discussing the treatment plan recommended by treating physicians, as well as initiating, if required, the Second Medical Opinion Process
• Providing 24/7 Preapprovals Call Support service to MetLife insured members
• Preparing Savings Report & working towards the Target set by Line Manager
• Communicating with the Providers/insured through emails/telephone regarding preapprovals.
• Providing support to Providers & Insured on the Pharmacy Management (Program PBM)
• Issuing ‘Guarantee of Payment’ letters to non-contracted Providers upon approval by the Line Manager
• Contributing to the on-going ‘Fraud & Abuse Capture’ process and apprising FWA team
• Ensuring that the preauthorisation requests are attended and reverted to within the Stipulated Turnaround Time
• Ensuring that call abandonment rate does not exceed the target set by Line Manager.
• Understand and adhere to all Compliance requirements, including but not limited to, reporting of suspicious transactions, screening requirements, as applicable, and the retention of Company records; plus provide timely support and unrestricted access to information as well as attend all training requests from Compliance.

QUALIFICATIONS, EXPERIENCE, & SKILLS:

• M.B.B.S (Medical) Degree is an essential requirement.
• Insurance experience would be preferred.
• LOMA or other insurance courses would be preferred.

About MetLife

Recognized on Fortune magazines list of the 2023 "Worlds Most Admired Companies", MetLife, through its subsidiaries and affiliates, is one of the world’s leading financial services companies; providing insurance, annuities, employee benefits and asset management to individual and institutional customers. With operations in more than 40 markets, we hold leading positions in the United States, Latin America, Asia, Europe, and the Middle East.

Our purpose is simple - to help our colleagues, customers, communities, and the world at large create a more confident future. United by purpose and guided by empathy, we’re inspired to transform the next century in financial services. At MetLife, it’s #AllTogetherPossible. Join us!