Senior Medical Reviewer – Inpatient Authorizations

About the role

MedNet Egypt is seeking an experienced Senior Medical Reviewer to evaluate inpatient medical authorizations and provide decisions through multiple communication channels. The role supports service providers and insured members by handling queries and ensuring compliance with medical necessity standards.

Key responsibilities

• Evaluate and authorize inpatient services for insured members via online platforms, fax, email, and phone.
• Conduct medical necessity and appropriateness assessments for in‑hospital cases.
• Respond to provider, insurance company, and member inquiries, maintaining high response rates in line with KPIs and SLAs.
• Perform primary medical auditing of inpatient claims received daily.
• Compile and analyze daily, weekly, and monthly statistical reports to monitor departmental performance and medical trends.
• Gather and act on customer feedback through surveys and direct interactions.
• Update medical files with investigation results (e.g., MRI, CT scans) and maintain chronic medication reports.

Required profile

• Bachelor’s degree in Medicine.
• Two to four years of relevant experience.
• Strong English communication skills, both written and verbal.
• Excellent interpersonal, negotiation, and leadership abilities.
• Analytical, problem‑solving, and decision‑making capabilities.

Required skills

• Proficiency with MS Office suite (Excel, PowerPoint).
• Database management skills.