Job Description

Responsibilities:

• Ensure timely review of ePAR and PBM cases and process as per prescribed guidelines and protocols. Responsible for issuing accurate Pre-approvals to the providers and deliver excellent customer service. Review pre-approval request and adjudicate as per defined policy terms and conditions/clinical/regulatory guidelines.
• Answer calls and emails from pharmacies, providers, and customers using exemplary customer service skills.
• Review clinical data matching it against specified medical terms and/or diagnosis /procedure codes and follow established procedure for authorizing preapproval request.
• Establish effective rapport with other employees and supervisor and maintain cooperative working relationship; actively support departmental activities.

Skills Required:

• Medically educated and trained with good overall business experience focusing on health insurance.
• Decision making skills to be able to authorize eligible cases.
• Very Good communication skills, verbal and written in English (required) and Arabic (preferable).
• IT skills including MS Office suite, health claim system, MIS.
• Medical coding knowledge.
• Business process design, reengineering, optimization and documentation (workflow, process maps).
• Lean, Six Sigma or other performance/quality improvement methodologies.

Qualifications:

• Bachelor’s degree in paramedical or /nursing. Medicine graduate would be preferred
• Insurance qualification/background is essential in similar role
• Minimum working experience 4-5 years (1-2 years in UAE) in preapproval role
• Candidate must have good exposure in preapproval and PBM
• Call Centre skills are mandatory
• Candidate must possess local market know-how and must be well versed with regulatory guidelines.