Medical Approval Team Leader

1 week ago

New Cairo, Cairo, Egypt MedNet Egypt L.L.C Full time

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 approvals team (Inpatient/ Outpatient or both) to assure that all requests are assessed & completed accurately in terms of Quality & SLA according to scope of coverage and medical Guidelines. Assuring effectiveness of workflow in the Medical department along with work distribution to the team.

Your Role

  • Oversee inpatient medical operations and ensure team productivity meets set targets and SLAs.
  • Conduct daily audits of medical approvals to ensure compliance with policy coverage and procedures.
  • Identify and investigate potential fraud or abuse cases from providers or clients.
  • Provide medical and technical guidance to department staff and support international accounts.
  • Plan and schedule manpower to optimize operational efficiency.
  • Participate in regional transformation projects and support other MedNet operations when needed.
  • Lead, coach, and develop staff to enhance performance and maintain processing quality.
  • Review treatment plans against medical guidelines, arrange second medical opinions, and monitor admitted cases.
  • Manage case steering by negotiating hospital costs, securing better treatment options, and maintaining referral matrices.
  • Handle provider, client, and insurer inquiries to ensure timely resolution and service excellence.
  • Prepare regular performance and medical trend reports, highlighting savings and operational outcomes.
  • Maintain accurate medical records, update chronic medication reports, and ensure proper documentation filing.

Your Profile

  • Bachelor's degree in medicine.
  • four years' experience in his/her educational field.
  • Experience in medical approval, call center and/or claims activities in the insurance industry or a TPA/MSO company would be a plus.
  • Computer literacy (MS Office, Excel, PowerPoint)
  • Good command in English
  • Excellent written and verbal communication skills
  • Strong leadership, planning and organizational skills
  • Analytical and problem-solving skills and database management skills
  • Decision making skills

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