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Medical Approval Officer

2 months ago

Riyadh, Ar Riyāḑ, Saudi Arabia Jordan River Foundation Full time

Job Title: Medical Approval Officer

About the Role:

We are seeking a highly skilled Medical Approval Officer to join our team at Jordan River Foundation. As a Medical Approval Officer, you will be responsible for handling relations with medical providers, negotiating discounts, and analyzing prior-approval requests.

Key Responsibilities:

  1. Medical Provider Relations: Establish and maintain strong relationships with medical providers, including negotiating discounts and studying price lists.
  2. Prior-Approval Requests: Analyze and negotiate prior-approval requests with medical providers, ensuring timely and cost-effective approvals.
  3. Claim Supervision: Supervise in-patient claims, including visits to patients during hospitalization, to ensure accurate and efficient processing.
  4. Medical Basics and Practice: Advise on medical basics and practice, providing expertise to support informed decision-making.
  5. Claim Processing: Assist medical claims administrators in processing claims, ensuring accuracy and efficiency.
  6. Medical Claim Validation: Validate all medical claims in the insurance system, ensuring compliance with regulations and policies.
  7. Client Communication: Communicate with insured members on their claims and any requests, providing exceptional customer service.
  8. Training and Development: Drive training and information seminars on insurance medical products, educating clients, prospects, and internal sales forces.
  9. Confidentiality: Ensure that all medical information is kept confidential, maintaining the highest standards of data protection.

Requirements:

To be successful in this role, you will need:

  • Strong knowledge of medical basics and practice
  • Excellent communication and negotiation skills
  • Ability to analyze complex medical data and make informed decisions
  • Strong attention to detail and organizational skills
  • Ability to work in a fast-paced environment and prioritize tasks effectively