Job Description

Neuron Health Services – A certified Great Place to Work is dedicated to simplifying healthcare and making it more accessible.

We prioritize seamless experiences, excellence in health insurance management, and innovative technology to better serve our clients and partners.

Rooted in our core values—Growth Mindset, Excellence, Resilience, Reliability, and Integrity—we provide clarity, protection, and efficiency at every step.

JOB PURPOSE

The Manager – OP Claims Processing & Authorization is responsible for leading and optimizing the end-to-end outpatient claims and authorization process. This role ensures timely, accurate, and compliant handling of claims and prior authorizations while driving operational efficiency, financial performance, and exceptional service standards.

RESPONSIBILITIES AND DUTIES

• Ensuring KPIs (Daily/Monthly) are met, if any deviations then need to be discussed with Supervisors/Assistant Managers on the action plan and mitigation measures. Responsible to maintain a minimum of 95% of agreed KPIs.
• Responsible to handle Reimbursement, Outpatient approvals, Inpatient approvals, case management functions.
• Work closely with PBM, Direct Billing claims, Payer Provider Support units to ensure daily operations are within regulatory requirements and payer agreed SLAs.
• Working closely with other internal departments (PMD, CCD, QA, UM, CRM, IT, Finance, Networks, Marketing) to ensure complete coordination and enabling smooth handling of TPA Operations.
• Review current SOPs and to revise or introduce new procedures and KPIs as per current market requirements and internal SLAs (to be done on quarterly basis).
• Mentoring of Supervisors/Assistant Managers and ensuring one-on-one counselling to be done per month.
• Creating Yearly objectives for team per role and weightage assigned and quarterly tracking on progress.
• Daily review with Supervisors/Assistant Managers for claims pipeline review along with queues on both preauthorization’s and claims processing. Discuss and implement action plans where necessary to mitigate any shortfalls.
• Review training plans for existing and new joiners on preauthorization and claims processing protocols. Identify gaps in performance and offer coaching to officers as needed.
• Identify training requirements within the team and perform training sessions. Preparation of training material (Policy, Medical, and Coding) with sign-off from managers. Ensuring to host at least 5 training sessions per year.
• Reviewing upheld complaints on monthly basis, root cause analysis, initiating any technical developments or team trainings required to mitigate these complaints from occurring in the future.
• Should have the ability to review, investigate and respond to internal inquiries/complaints and provide guidance to others related to medical necessity.
• Monitor the procedural (99%) and financial accuracy of team (99%) and ensuring that quality parameters are discussed with the reporting team members and improvement on quality to be tracked and reported to Senior manager.
• Discuss with Head of Medical Operations on staff performance reviews and leave scheduling. Assisting on leave planner and assist in maintaining operational efficiency during shift and ensuring all necessary measures are taken to optimize and maintain KPIs expected.
• Create reports based on operational requirements to monitor KPIs and prepare action plan for any mitigation steps required.

KNOWLEDGE, SKILLS, AND EXPERIENCE

• University degree in any discipline of Medical/Para-medical specialization, Bachelors of Dentistry or Dental Surgery BDS, MBBS, MD, BAMS, BHMS, from a reputable university.
• Healthcare/Hospital/Clinic experience for 1-2 years, in departments such as Surgery, ICU or GP, is required.
• 5-7 years of work experience in the Insurance industry is preferable.
• Expert Knowledge of Medical Terminologies, CPT codes and ICD codes.
• CPC certification is mandatory.
• Must be computer literate with good MS excel, Word, PPT skills.
• Multilingual, excellent command of the English language, Arabic is a definite plus.
• Ability to work under pressure, attention to detail, and meet tight deadlines and varying work-schedules. To work as per business requirements where necessary.

BENEFITS ON OFFER

Market-based package.

Medical & Life Cover, Company transport, Health & Wellness programs, Personal development and growth opportunities

Benefits found in job post

• Medical insurance