Department: Life & Medical
Working Hours: Subject to shift schedule
Purpose of the Role
The role focuses on the accurate and timely processing of pre-authorization requests, ensuring compliance with regulatory standards, supporting cost containment and fraud prevention initiatives, and requires strong knowledge of medical insurance terminologies, diseases, diagnostics, procedures, as well as familiarity with digital and physical archiving systems.
Key Responsibilities:
- Process pre-authorization requests for direct billing, reimbursement, and pharmacy services
- Review and validate claims documentation in accordance with policy guidelines and Financial Services Authority regulations
- Perform medical coding and mapping using standardized codes for accurate claim adjudication
- Support direct billing and reimbursement claims processing, including sample verification and quality control
- Monitor claim trends to assist in cost containment and prevent abuse or excessive utilization
- Conduct remote provider audits on a case-by-case and periodic basis to ensure compliance and billing accuracy
- Generate and analyze provider claims reports to detect anomalies such as revenue spikes or unusual billing patterns
- Collaborate with the call center team to provide technical support and clarify queries related to medical approvals and insurance procedures
Educational Qualifications:
- Bachelor’s degree in Health Science, Pharmacy, Physiotherapy, Nursing, or Dentistry
- Strong communication skills in English; Arabic is an advantage
Experience:
- Minimum 2 years of experience in a similar role or medical claims/health insurance processing
