Medical Pre-Approvals Officer
صاحب العمل نشط
حالة تأهب وظيفة
سيتم تحديثك بأحدث تنبيهات الوظائف عبر البريد الإلكتروني
شارك هذه الوظيفة
حالة تأهب وظيفة
سيتم تحديثك بأحدث تنبيهات الوظائف عبر البريد الإلكتروني
الوصف الوظيفي
ONLY FILIPINO NATIONALS NEED APPLY
Job Purpose:
We are looking for a qualified Executive to join our medical pre-approval team. The role involves evaluating pre-approval requests for medical procedures and treatments ensuring they meet clinical standards and adhere to the table of benefits and health protocols. The ideal candidate will collaborate with healthcare providers and internal teams to ensure decisions are medically justified efficient and customer focused.
Key Responsibilities:
- Review and adjudicate medical pre-approval requests and assess clinical necessity
- Analyze clinical documents and patient history to determine the appropriateness of proposed treatments
- Communicate with healthcare providers to obtain clarification and additional documentation when required
- Provide clinical recommendations based on established medical guidelines and best practices
- Ensure adherence to insurance regulations internal protocols and medical table of benefits.
- Analyze and evaluate preapproval trends from medical providers and detect abnormalities.
- Ensure strict adherence to regulatory requirements and company pre-approval policies
- Resolve disputes related to medical pre-approvals in a fair evidence-based manner
Educational Qualifications:
- Bachelors degree in health science Pharmacy Physiotherapy Nursing or Dentistry
Experience:
- Minimum 2 years of relevant experience in medical related field or preapproval function.
Key Skills:
- Solid understanding of medical treatments procedures and terminology.
- Skilled in critically assessing medical documentation to support informed decision-making.
- Excellent bilingual verbal and written communication skills for effective collaboration with healthcare providers and team members.
- High accuracy in evaluating claims and ensuring adherence to policies.
- Proficient in managing complex or ambiguous cases using sound clinical judgment.
نوع التوظيف
دوام كامل
