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

DAMANA

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