Medical Approval Officer
6 days ago
About Pharmacy One
We are seeking a highly skilled Medical Approval Officer to join our team in Riyadh, KSA. As a Medical Approval Officer, you will play a critical role in ensuring the smooth operation of our insurance medical products.
Key Responsibilities:
- Medical Provider Relations: Establish and maintain strong relationships with medical providers, including negotiating discounts, analyzing price lists, and handling reconciliations.
- Prior-Approval Requests: Analyze and negotiate prior-approval requests with medical providers, approve cases when agreements are reached, and enter claims into the insurance system.
- In-Patient Claims: Supervise in-patient claims, including visits to patients during hospitalization, to ensure accurate and timely processing.
- Medical Basics and Practice: Provide expert advice on medical basics and practice to support the development of our insurance medical products.
- Medical Claims Administration: Assist medical claims administrators in processing claims, ensuring that all medical information is accurate and up-to-date.
- Claim Validation: Validate all medical claims in the insurance system to ensure compliance with regulatory requirements.
- Customer Communication: Communicate with insured members regarding their claims and any requests from insured members, providing exceptional customer service.
- Training and Development: Drive training and information seminars on insurance medical products to clients, prospects, and internal sales forces, enhancing their knowledge and understanding of our products.
- Confidentiality: Ensure that all medical information is kept confidential, adhering to strict data protection policies.
Requirements:
- MBBS degree
- Strong knowledge of medical basics and practice
- Excellent communication and negotiation skills
- Ability to work in a fast-paced environment
- Strong analytical and problem-solving skills
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