Medical Approval Officer

6 days ago


Riyadh, Ar Riyāḑ, Saudi Arabia Capital Bank Group Full time

Job Summary: We are seeking a highly skilled Medical Approval Officer to join our team at Capital Bank Group. As a Medical Approval Officer, you will be responsible for handling relations with medical providers, analyzing prior-approval requests, and supervising in-patient claims.

Key Responsibilities:

  1. Medical Provider Relations: Establish and maintain strong relationships with medical providers, including negotiating discounts, studying price lists, and conducting regular visits.
  2. Prior-Approval Requests: Analyze and negotiate prior-approval requests with medical providers, ensuring timely and cost-effective approvals.
  3. In-Patient Claims Supervision: Supervise in-patient claims, including visits to patients during hospitalization, to ensure accurate and efficient processing.
  4. Medical Basics and Practice: Provide expert advice on medical basics and practice to internal stakeholders and clients.
  5. Medical Claims Administration: Assist medical claims administrators in processing claims, ensuring compliance with regulatory requirements.
  6. Medical Claims Validation: Validate all medical claims in the insurance system, ensuring accuracy and completeness.
  7. Client Communication: Communicate with insured members on their claims and requests, providing timely and effective support.
  8. Training and Development: Develop and deliver training programs on insurance medical products to clients, prospects, and internal sales teams.
  9. Confidentiality: Ensure the confidentiality of all medical information, adhering to strict data protection protocols.

Requirements: To be successful in this role, you will need a strong understanding of medical basics and practice, excellent communication and negotiation skills, and the ability to work in a fast-paced environment.



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