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Associate, Preauthorization (Contract)
Sukoon Insurance
Dubai, UAE
Contract
Entry
Onsite
Discovered 2 weeks ago
ePARPBMPreauthorization and preapproval processingHealth insuranceMedical codingClinical data and diagnosis/procedure codes
Free
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ePARPBMPreauthorization and preapproval processing
Role Overview
The jobholder processes ePAR and PBM cases through calls and emails.
The role reviews clinical and insurance information to authorize eligible preapproval requests.
Key Skills for This Role
ePARPBMPreauthorization and preapproval processingHealth insuranceMedical codingClinical data and diagnosis/procedure codes
Full Job Posting
Role Overview
The jobholder processes ePAR and PBM cases through calls and emails.
The role reviews clinical and insurance information to authorize eligible preapproval requests.
Responsibilities
- Review ePAR and PBM cases promptly according to prescribed guidelines and protocols.
- Issue accurate pre-approvals to providers and deliver excellent customer service.
- Adjudicate requests according to policy terms, clinical guidelines, and regulatory requirements.
- Answer calls and emails from pharmacies, providers, and customers.
- Match clinical data against medical terms and diagnosis or procedure codes.
- Maintain cooperative working relationships and support departmental activities.
Required Skills
- Medical education and health insurance business experience are required.
- Decision-making skills are needed to authorize eligible cases.
- Very good written and verbal English communication skills are required; Arabic is preferable.
- IT skills include MS Office, health claims systems, and MIS.
- Medical coding knowledge and call-centre skills are required.
- Business process design, reengineering, optimization, and documentation knowledge is required.
- Lean, Six Sigma, or other performance and quality improvement methodology knowledge is listed.
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