Medical Officer – Client of Five Continents in Abu Dhabi
Ensure effective administration of the Companyâ€™s Medical scheme and provide quality medical services to all company employees. The successful candidate should be able to carry-out the following: – Close coordination with MOH, medical service providers, Hospitals/Clinics, emergency and other support services and with ADNOC Medical department to ensure Company employees receive prompt and quality medical care. – Effective follow up and prompt resolution of all medical cases – To ensure that the medical services provided are responsive to the employees needs and requirements – Coordinating the processing of all medical cases and employeeâ€™s medical claims with the medical service providers and Insurance Company to ensure employee/customer satisfaction – Regular liaison with ADNOC Medical Department and ADNOC Clinic for pre- employment medical examination, employeeâ€™s medical check-up, medical case clarifications ,medical treatment abroad and disability payment – Regular visits and follow up of employees undergoing medical treatment in Hospitals as well as assisting employees families in critical medical cases – Coordination with Ministry of Health authorities on matters relating to preventive health care as well as with contracted hospitals regarding executive health check-up for senior management – Investigating and effectively resolving employeeâ€™s complaints on medical services, reimbursements, insurance matters and medical treatment. – Reviews and evaluates all medical cases and sick leaves and prepares necessary reports and recommendation for management review. – Collects and maintains statistical data on a monthly basis and prepares periodic reports and updates as required – Participates in risk management, claim adjudication and pharmacy utilization, case reviews, site visit coordination and assessment of medical service providers – Promotes wellness and ensures that Health awareness programs and preventive care are consistent with the Departmentâ€™s plans and objectives. – Maintains up to date knowledge of new information in the medical field and their application to the Companyâ€™s Health plan and Medical policy. – Assists in the contracting process of medical service providers, Insurance Company, hospitals, ancillary providers and emergency and other support services and in evaluation of the medical aspects of provider contracts. – Implements the health plan medical policies, goals and objectives and assures plan conformance with legal and regulatory requirements. – Collaborates with ADNOC Medical Department in creating and maintaining programs to achieve preventive health care, cost and quality outcomes. – Monitors member and provider satisfaction survey results and implements changes as needed to increase satisfaction and assure that satisfactory relationships are maintained between network providers and plan participants.
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