Job Status: Active
One of our client is looking to hire Officer – Medical Pre-Approvals (Medical Insurance)
Key Responsibilities
· Review and adjudicate medical pre-approval requests and assess clinical necessity
· Analyze clinical documents and patient history to determine the appropriateness of proposed treatments
· Communicate with healthcare providers to obtain clarification and additional documentation when required
· Provide clinical recommendations based on established medical guidelines and best practices
· Ensure adherence to insurance regulations, internal protocols, and medical table of benefits
· Analyze and evaluate pre-approval trends from medical providers and detect abnormalities
· Ensure strict adherence to regulatory requirements and company pre-approval policies
· Resolve disputes related to medical pre-approvals in a fair, evidence-based manner
Requirements
· Bachelor’s degree in Health Science, Pharmacy, Physiotherapy, Nursing, or Dentistry
· Minimum 2 years of relevant experience in a medical-related field or pre-approval function
· Solid understanding of medical treatments, procedures, and terminology
· Skilled in critically assessing medical documentation to support informed decision-making
· Excellent bilingual communication skills (verbal and written) for effective collaboration with healthcare providers and team members
· High accuracy in evaluating claims and ensuring adherence to policies
· Proficient in managing complex or ambiguous cases using sound clinical judgment
How to Apply
Interested contenders may apply by emailing their updated profiles to recruitment@metierme.net with the subject line: ‘Officer – Medical Pre-Approvals’
Please note that only shortlisted candidates will be contacted for further discussion.