Medical Approval Specialist

2 days ago

Al Khobar, Saudi Arabia Blue Hat HR Services Full time

**Job Brief**:
Are you a medically qualified professional experienced in handling medical approvals and insurance coordination? Do you have a strong understanding of clinical evaluation and policy compliance?
If so, **you are the one we are looking for**

This is an excellent opportunity to join a reputed medical insurance management team, where you will evaluate treatment requests, ensure compliance with medical guidelines, and maintain accuracy in medical authorization processes while working closely with healthcare providers.

**Key Responsibilities**:

- Evaluate **prior authorization requests** for medical necessity based on provided medical reports and documentation.
- **Code medical services** accurately and classify cases (inpatient, outpatient, emergency, etc.) as per standard clinical practices.
- Verify that all requested services comply with **best medical practices** and **insurance policy terms**.
- Identify, document, and **report misuse or potential fraud cases**, ensuring necessary preventive actions are implemented.
- **Monitor utilization patterns**, detect early warning signs, and recommend cost-control measures.
- Respond promptly to inquiries from hospitals, clinics, and pharmacies to ensure smooth **case coordination**.
- Handle **second opinion and case management requests** and escalate complex cases to senior medical officers.
- Participate in **night shifts and holiday rosters** as assigned.
- **Prepare daily and monthly activity reports** as required by management.
- Validate the **accuracy of services and pricing**, identifying areas for cost optimization.
- Communicate with clients and providers in a professional and timely manner in accordance with company guidelines.
- Perform any other duties assigned by the direct supervisor related to the role.

**Required Qualification / Experience / Skills**:

- Bachelor’s or Master’s Degree in _General Medicine & Surgery_.
- **Min 1**year of Saudi experience in medical approvals, insurance claims, or healthcare administration
- Familiarity with medical coding systems (ICD, CPT, etc.)
- Strong understanding of clinical practices and medical policy interpretation
- Proficiency in Microsoft Office and healthcare management systems
- Excellent communication and coordination abilities
- Strong analytical and decision-making skills
- Ability to handle multiple cases efficiently under pressure

**Job Location: Saudi Arabia**

**Type of Employment: Permanent / Full-time**

**Salary Range: 7,000 - 12,000 SAR based on experience**

**What you can expect from the employer**:
Competitive salary package based on experience

Dynamic and growth-oriented work environment

Training and career advancement opportunities

All other benefits as per Saudi Employment Law

**Job Types**: Full-time, Permanent

Pay: ﷼7,000.00 - ﷼12,000.00 per month

Application Question(s):

- Do you hold a Bachelor’s or Master’s degree in General Medicine & Surgery?
- How many years of experience do you have in medical approvals or insurance management?
- Are you familiar with medical coding systems (ICD, CPT, etc.)?
- Are you willing to work rotational night shifts and on official holidays?
- Do you have prior experience in coordinating with hospitals, clinics, or insurance providers?

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