Medical Officer Precertification Associate

About the company

Allianz Partners is a world leader in B2B2C insurance and assistance, offering global solutions that span international health and life, travel insurance, automotive, and assistance. Customer driven, our innovative experts are redefining insurance services by delivering future-ready, high-tech, high-touch products and solutions that go beyond traditional insurance. Our products are embedded seamlessly into our partners' businesses or sold directly to customers, and are available through four commercial brands: Allianz Assistance, Allianz Automotive, Allianz Travel, and Allianz Care.

At Allianz Partners, artificial intelligence (AI) is transforming service delivery and innovation. By leveraging business intelligence and data analytics, we enhance strategic decision-making and customer experiences. Our commitment to ethical AI ensures responsible deployment, maintaining data integrity and trust. Conversational AI improves communication, while emerging technologies and generative AI drive industry leadership and new opportunities. With robust information security management, we protect sensitive information, ensuring compliance and security. Embrace the future of AI with Allianz Partners, where possibilities become realities.

Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams, and challenges is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow, and to shape a better future for our customers and the world around us.

Your tasks

Medical officer - outpatient precertification is responsible for managing the outpatient precertification claims while ensuring that departmental goals, timeline of activities, and compliance measures are met.

• Precertification team is functional on a 24/7 basis. Therefore, the medical officer will work on a flexible shift basis as per the schedule provided by the team leader.
• Adjudicates outpatient medical claims by evaluating each case from both the technical and clinical perspectives, ensuring all decisions comply with policy terms and conditions and are delivered within the stipulated turnaround time and quality standards.
• Performs a comprehensive review of outpatient documentation, including consultation notes, diagnostic reports, laboratory results, radiology findings, prescriptions, treatment plans, and follow-up notes to validate medical necessity and appropriateness of care.
• Assesses the necessity and justification of proposed treatment plans, ensuring alignment with evidence-based guidelines and outpatient benefit structures.
• Requests additional medical documentation or identifies missing information essential for accurate decision-making, coordinating with providers when clarification is required.
• Conducts utilization review for outpatient services, including but not limited to evaluation of billed items, non-covered services, overutilization patterns, and appropriateness of investigations or procedures.
• Performs review of claims as per CPT and ICD coding guidelines in line with insurance regulators (DHA, DOH/HAAD, MOH).
• Adheres to cost-containment protocols by ensuring outpatient services are medically justified, appropriately billed, and aligned with network rules and negotiated tariffs.
• Maintains daily productivity and service level targets, ensuring timely adjudication and consistent workflow management.
• AI readiness: Work effectively in an environment shaped by artificial intelligence (AI), machine learning, data, analytics, and cloud-based tools, using insights responsibly with our standards of data governance, security, and ethical use.

Requirements

• Bachelor's degree in dentistry, nursing, or paramedics.
• 1-3 years of medical practical experience (reputable insurance provider, broker, or a TPA experience is a plus).
• Physically fit to carry out duties.
• Certified medical coder (preferable).
• Legally permitted to work in the country of operations.
• Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.
• Strong English communication skills, both verbal and written, with excellent interpersonal and stakeholder management abilities.
• Knowledge of Abu Dhabi and Al-Ain markets.

Other

How we hire Agency statement: Allianz Partners does not accept unsolicited CVs or approaches from agencies. We only work with partners on our approved supplier list, under contract. Any unsolicited submission will not be considered.

At Allianz, we stand for unity: we believe that a united world is a more prosperous world, and we are dedicated to consistently advocating for equal opportunities for all. The foundation for this is our inclusive workplace, where people and performance both matter, and nurtures a culture grounded in integrity, fairness, inclusion, and trust.

We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, social class, disability, sexual orientation, or any other characteristics protected under applicable local laws and regulations.

Note: Having different strengths, experiences, perspectives, and approaches is an integral part of Allianz's company culture. One means to achieve this is a regular rotation of Allianz executive employees across functions, Allianz entities, and geographies. Therefore, the company expects from its employees a general openness and a high motivation to regularly change positions and collect experiences across Allianz Group.