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Medical Approval Specialist

2 months ago

Riyadh, Ar Riyāḑ, Saudi Arabia Pharmacy One Full time

Pharmacy One is seeking a highly skilled Medical Approval Officer to join our team in Riyadh, KSA.

About the Role:

We are looking for a seasoned professional with a strong background in medical approvals to handle relations with medical providers, analyze prior-approval requests, and supervise in-patient claims.

Key Responsibilities:

  1. Medical Provider Relations: Negotiate discounts, study price lists, handle reconciliations, and visit medical providers regularly to ensure seamless operations.
  2. Prior-Approval Requests: Analyze and negotiate cases with medical providers, approve cases when an agreement is reached, and enter claims into the insurance system.
  3. In-Patient Claims: Supervise and validate in-patient claims, including visits to patients during hospitalization.
  4. Medical Basics and Practice: Advise on medical basics and practice to ensure compliance and quality standards.
  5. Claims Administration: Assist medical claims administrators in processing claims and validating medical information.
  6. Communication: Communicate with insured members regarding their claims and any requests from insured members.
  7. Training and Seminars: Drive training and information seminars on insurance medical products directed toward clients, prospects, and internal sales forces.
  8. Confidentiality: Ensure that all medical information is kept confidential.

Requirements:

We require a local candidate with a strong background in medical approvals and excellent communication skills.

How to Apply:

Please send your CV to the relevant contact person.