Senior Medical Officer

About the role

MedNet Egypt, a leading managed‑care service provider, is seeking a Senior Medical Officer to oversee medical authorizations for outpatient services. The role involves evaluating requests, communicating decisions, and supporting service providers through various channels such as online portals, fax, email, and phone.

Key responsibilities

• Provide overall guidance on medical case review, evaluation, and authorization ensuring compliance with policy guidelines.
• Revise and confirm application of TOB, PIC Exclusion List, and policy amendments with relevant departments.
• Train new MCC members on policies, procedures, medical guidelines, and chronic care cycles.
• Respond to client inquiries via fax, email, and phone.
• Approve and enter all chronic modules (new and renewed policies) and coordinate with the account management team on approved or rejected cases.
• Review monthly chronic incidents for technical and medical guideline compliance.
• Request re‑consultations for non‑justified cases and follow up with the account management team.
• Renew exceptions per policy and member requirements.
• Monitor medical trends, identify fraudulent cases, and alert the medical team leader.

Required profile

• Bachelor’s degree in Pharmacy or Dentistry.
• 3‑5 years of experience in the relevant field; insurance experience is a plus.
• Fluent English with excellent verbal and written communication.
• Strong time‑management, analytical, and problem‑solving abilities.
• Ability to handle stress and make decisive decisions.

Required skills