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Medical Approval Officer

2 months ago

Riyadh, Ar Riyāḑ, Saudi Arabia Shawarmer Food Company LLC. Full time

Job Summary:

We are seeking a highly skilled Medical Approval Officer to join our team at Shawarmer Food Company LLC. in Riyadh, KSA. 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: Negotiate discounts, study price lists, handle reconciliations, and visit medical providers regularly to ensure smooth operations.
  2. Prior-Approval Requests: Analyze requests, negotiate cases with medical providers, approve cases when agreements are reached, and enter claims into the insurance system.
  3. In-Patient Claims: Supervise in-patient claims, including visits to patients during hospitalization, to ensure accurate and timely processing.
  4. Medical Basics and Practice: Advise on medical basics and practice to ensure compliance with industry standards.
  5. Medical Claims Administration: Assist medical claims administrators in processing claims to ensure efficient and accurate claims handling.
  6. Medical Claims Validation: Validate all medical claims in the insurance system to ensure accuracy and compliance.
  7. Client Communication: Communicate with insured members regarding their claims and any requests from them to ensure excellent customer service.
  8. Training and Development: Drive training and information seminars on insurance medical products to educate clients, prospects, and internal sales forces.
  9. Confidentiality: Ensure that all medical information is kept confidential to maintain trust and integrity.

Requirements:

MBBS degree and relevant experience in medical claims administration or a related field.