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Senior Medical Reviewer - Rule Engine

MedNet Global Healthcare Solutions LLC

Posted on November 6, 2019

4 - 5 years Cairo - Egypt

MBBS(Medicine). Any Nationality

Opening 01

Job Description

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For MedNet Egypt
As a member of Munich Re the MedNet Group is a leading TPA across the MEA region. We are currently seeking to hire a Senior Medical Reviewer Rule Engine with the following tasks and responsibilities:
Your Job:
• Ensure delivering medical rules in the highest standards within the agreed targets.
• Ensure the quality of the medical rules delivered to My Detect is update Identification of obstacles and implementations of solutions in liaison with stakeholders for the project, operational managers,
business partners and Vendors.
• Liaise with claims department to ensure the MRE performance is up to the highest standards.
•Liaise with the respective Manager and HoO in deployment of any POC or pilot project for any prospective clients.
• Testing of all raised technical developments in Rule engine as well as supporting systems, medical rule engine
automation.
• Rule development for MRHT shield client.
• Ensure that the rule maintenance and development process abide to the governance structure shared.
• Development of rules as per trends and analysis and implementation of rules are per operational requirements and in liaison with operational teams/committee.
• Random audits of systems as well as data to ensure highest quality in functioning of the rule engine.
Your Profile:
• Medical Degree from a school recognized by the WHO.
• Medical knowledge and proved medical practice.
• Minimum of 4 to 5 years experience in health insurance field.
• Should have a track record of having managed a team.
• Experience in project management with successful implementation of at least one project in health insurance related field.
• Clinical knowledge, including latest clinical guidelines.
• Knowledge of medical coding ICD and CPT.
• Industry knowledge related to local healthcare services system.
• Strong leadership, planning and organizational skills.
Munich Re not only stands for fairness with regard to its clients; it is also an equal opportunities employer


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Senior Medical Reviewer - Rule Engine

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MedNet Global Healthcare Solutions LLC


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