Job Description
The Medical Governance Specialist will work within the Medical Benefits team and will support medical governance operational activities including framework policies, adjudication guidelines, quality indices framework, and quality audit policies.
Duties and Responsibilities
Your main responsibilities in this role include the following:
Identify, research, develop and train medical and insurance decision making guidelines based on international best practice and evidence based medicine
Create and manage a database of references for claims, approvals and governance utilisation
Update quality framework and policies across all MB functionalities
Monitor and analyse trends across all towards sourcing reference for consistent decision making
Monitor and plot efficiency metrics
Oversee pricing matrix for network tariff
Job Requirements
Educated to Bachelors level in Medicine
5 years work experience with a minimum of 3 years in a clinical setting and 2 years in a medical insurance role
Computer literate, Proficiency in the MS Office Suite of Software (Excel/Word/Power Point).
Proficiency in written and spoken English.
Job Details
Company/Organization: Emirates
Employment Type: Full-time
Job Location: Dubai, United Arab Emirates
