Medical Insurance Doctor - Approval
Skills
About This Role
Overview
Our TPA in Dubai is currently looking for a Medical Doctor with 3-5 years of experience in medical approvals/claims.
Job Summary
- The Medical Approval Specialist is responsible for reviewing and approving payment on pre-approvals received from hospitals/clinics; the incumbent will respond to all members/clients queries ensuring high level of customer medical necessity and satisfaction.
Main Responsibilities
- Consult with the Provider Relation Department for any discrepancy in price or CPT code of the provider pre-approval.
- Coordinate & follow up with Clinical Team for any complex admission case.
- Respond to clients/members calls and queries related to their pre-approvals status , eligibility, plan benefit coverage and other queries related to member’s policy terms & conditions.
- Handle medical cases related to areas of specialization.
- Book every call/ complaint and Support the Customer Service Department for any query related to clients’ pre-approvals.
- Assist in the department process improvements and make recommendations to Team Leader.
- Process requests for pre-certification from providers (hospitals/clinics) in the approvals module of the Company’s Claims Management System (CMS) by applying policy terms and conditions.
- Adhere to the contents of the Operating Procedures Manual (OPM) and the Company’s overall procedures and policies.
- Miscellaneous tasks within the scope of work, as assigned by the direct manager.
- Schedule on rotated shifts and weekends as assigned by the direct manager.
Qualifications
- MBBS
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