Medical Approval Specialist
6 days ago
About Mlabbas
Mlabbas is a leading provider of insurance services, dedicated to delivering exceptional solutions to our clients.
Job Summary
We are seeking a highly skilled Medical Approval Officer to join our team. The successful candidate will be responsible for handling relations with medical providers, negotiating discounts, and analyzing prior-approval requests.
Key Responsibilities
- Medical Provider Relations
Establish and maintain strong relationships with medical providers, including negotiating discounts and studying price lists.
- Reconciliation and Site Visits
Handle reconciliations and conduct regular site visits to medical providers to ensure compliance and quality of service.
- Prior-Approval Requests
Analyze prior-approval requests and negotiate cases with medical providers to ensure timely and cost-effective resolution.
- Case Approval and Claims Entry
Approve cases when agreement is reached and enter claims into the insurance system, ensuring accurate and efficient processing.
- In-Patient Claims
Supervise in-patient claims, including visits to patients during hospitalization, to ensure seamless and compassionate care.
- Medical Advisory Services
Advise on medical basics and practice, providing expert guidance to internal stakeholders and clients.
- Claims Administration
Assist medical claims administrators in processing claims, ensuring timely and accurate resolution.
- Medical Claims Validation
Validate all medical claims in the insurance system, ensuring compliance with regulatory requirements and company policies.
- Client Communication
Communicate with insured members regarding their claims and requests, providing exceptional customer service and support.
- Training and Development
Drive training and information seminars on insurance medical products for clients, prospects, and internal sales forces, enhancing knowledge and expertise.
- Confidentiality and Data Protection
Ensure all medical information is kept confidential, adhering to strict data protection policies and procedures.
Requirements
The ideal candidate will possess 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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