MedNet Egypt is one of the leading managed care service organizations that caters to healthcare needs. We are looking for a skilled Medical Team Leader who will Manage and direct the Outpatient Team in order to assure that all incoming medical approvals requests from the Client, Broker & Account Management were processed efficiently and accurately according to scope of coverage and the agreed SLA. Assuring effectiveness of workflow along with work distribution to the team.

Your Job

• Manage the turnaround time of the medical approval requests and ensure the achievement of the SLA with high quality.
• Ensure that medical cases and customers’ queries are solved according to the company quality standards to reach customer medical necessity and satisfaction.
• Detecting, preventing, and following up on PH utilization and investigating fraud and abuse cases from providers or clients.
• Managing the international accounts and responsible for project Management/ Outpatient (EX: Pricelists revision to increase the automaticity and enhance our SLA, assembling all PICs exclusions all together & linking them with edit rules on MedNext to facilitate & enhance the decision-making process and handle all system issues for Live or Beta MN+ environment.
• Responsible of the outpatient rules-building criteria versus policies Table of benefits and testing new policy configurations to ensure that each benefit is built correctly.
• Managing & handling customers, Brokers, and PICs queries through phone and email, answering any inquiries received from them.
• Develop a timeline to achieve targets, schedule, and plan the Manpower. Preparing medical statistical analysis daily & preparing the monthly KPI for the medical team (Inpatient & Outpatient) and monitoring medical team productivity through conducting quarterly performance reviews according to set targets.
• Motivate and empower the team with skills to improve their confidence, product knowledge, and communication skills and delegate tasks to achieve organizational goals.
• Manage the effective achievement of objectives through setting individual objectives, managing performance, developing staff, and providing formal and informal feedback to maximize overall performance and team motivation.
• Responsible for supporting the claims department with any issues related to medical authorizations and following up with other departments to resolve medical approval issues.

Your Profile

• Bachelor’s degree in medicine, pharmacy, Dentistry.
• Minimum 4 years’ experience in Medical Management TPA / medical insurance sector.
• Very good computer skills (MS Office, Excel, PowerPoint).
• Industry knowledge related to local healthcare services system would be a plus.
• Fluent English language
• Attention to details.
• Strong leadership, planning and organizational skills.
• Excellent interpersonal, verbal and written communication skills.
• Quality focus and customer oriented.