Medical Assessor – Outpatient Precertification

About the role

The Medical Assessor – Outpatient Precertification evaluates outpatient medical claims to ensure clinical appropriateness, policy compliance, and cost‑effectiveness. Working on a 24/7 shift schedule, the role supports timely adjudication and utilization review for a leading insurance provider.

Key responsibilities

• Adjudicate outpatient claims by reviewing clinical documentation, diagnostic reports, prescriptions, and treatment plans.
• Validate medical necessity against evidence‑based guidelines and benefit structures.
• Request additional information from providers and coordinate clarifications.
• Conduct utilization reviews, identify non‑covered services, and monitor over‑utilization patterns.
• Apply CPT and ICD coding standards in line with local regulators (DHA, DOH/HAAD, MOH).
• Ensure cost‑containment by confirming services are medically justified and correctly billed.
• Maintain daily productivity targets and meet service level agreements.
• Utilize AI‑enabled tools and analytics while adhering to data governance and security standards.

Required profile

• Bachelor’s degree in Pharmacy, Dentistry, Medicine, Nursing, Physiotherapy or Paramedics.
• 0–2 years of medical practical experience in insurance, brokerage or TPA environments (entry level accepted).
• Legal right to work in the country of operation.
• Physically fit to perform duties.

Required skills

• Proficiency in MS Office (Excel, Word, Outlook, PowerPoint).
• Knowledge of CPT and ICD coding guidelines.
• Certified Medical Coder (preferred).

What we offer

• Opportunity to work with a global leader in B2B2C insurance and assistance.
• Exposure to AI‑driven analytics and cloud‑based tools.