Duties:

• Evaluate medical necessity of procedures and/or treatments as well as the length of stay for outpatient and inpatient cases
• Review all the medical information for completeness
• Assess and decide on the medical necessity using evidence-based medicine
• Help teams to assess the medical expenses when requested.
• Participate actively to the case management:
• Proactively engage with provider (by phone or email) to obtain information needed to assess a case and challenge Doctor when needed
• Call member to obtain information when appropriate
• Provide medical expertise to the operation teams.
• Give medical information and travel/medical recommendations to the Assistance’s clients.
• Manage the team and monitor the performance.
• Track and monitor the cases’ volume
• Handle ad hoc activity as requested by the Regional Head of Medical.

Requirements:

• A degree in nursing or medical sciences
• At least 3 years of work experience in nursing, a previous experience in Assistance or an operational role in Insurance is a plus
• Excellent verbal and written communication skills, including the ability to effectively communicate with local and international stakeholders
• Confident to challenge a decision and provide argumentation to support it
• Capacity to work under limited supervision and to take the initiative