Medical Insurance Doctor - Approval

Job Description

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.

• 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.

• MBBS