Authorization Specialist

4 weeks ago


Dubai, Dubai, United Arab Emirates Jobs via eFinancialCareers · Full time

OVERVIEW: The Authorization Specialist plays a crucial role in securing prior approvals for all medical procedures by efficiently navigating the authorization process with various commercial insurers, ensuring compliance with established turnaround times to uphold team performance metrics.

KEY RESPONSIBILITIES:

  • Evaluate medical approval requests and adherence to policy guidelines.
  • Verify the necessity of treatment plans for patients.
  • Regularly document both verbal and written claims approvals.
  • Make decisions on approvals based on policy stipulations.
  • Assess high-cost claims and render decisions on complex cases.
  • Provide clear and concise feedback to inquiries from the call center team.
  • Assist clients in understanding any denied medical claims.
  • Coordinate workflow to meet established deadlines.
  • Review claims for eligibility criteria.
  • Achieve daily productivity targets for Precertification based on claim types and tenure.
  • Process Outpatient Precertification on a first-in-first-out basis.
  • Maintain a productivity turnaround time of 85% within 10 minutes and 98% within the first hour, including urgent and VIP cases.
  • Adhere to a 100% schedule and punctuality requirement.
  • Exercise decision-making authority.
  • Effectively evaluate high-cost claims to meet daily team targets, granting approvals in accordance with guidelines and policy terms, while considering market practices, with significant accountability for invalid rejections and customer satisfaction.
  • Support the training of new team members and provide constructive feedback.
  • Keep the workflow guidelines updated.

QUALIFICATIONS:

  • Bachelor's degree in Pharmacy.
  • A minimum of 4 years of practical medical experience, preferably with a reputable insurance provider, broker, or TPA.
  • Proficiency in MS Office Suite (Excel, Word, Outlook, PowerPoint) and strong internet navigation and research skills.


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