Medical Insurance Doctor

1 week ago


United Arab Emirates Dubai DAMANA Full time

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. Main Responsibilities - 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. Qualifications - MBBS



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