Job Description Health Support Associate

Position Title

Health Support Associate

Job Summary

The Health Support Associate is responsible for providing operational administrative and medical support for health insurance services. The role assists in member eligibility verification pre-authorizations medical claims review and coordination with healthcare providers to ensure efficient service delivery. The Health Support Associate also provides accurate medical guidance while ensuring compliance with company policies service standards and regulatory requirements.

Key Responsibilities

Member & Customer Support

• Serve as the primary point of contact for policyholders hospitals clinics and corporate clients regarding health insurance inquiries.
• Verify member eligibility policy benefits and coverage.
• Respond to customer inquiries through phone email and online portals in a timely and professional manner.
• Escalate complex medical or operational issues to the Medical Officer or relevant department.

Medical Claims & Pre-Authorization

• Review medical documents and assist in evaluating claims for completeness and medical appropriateness.
• Coordinate with healthcare providers regarding pre-authorizations referrals and treatment approvals.
• Ensure required medical documentation is complete before processing requests.
• Support case management and utilization review activities.

Provider Coordination

• Liaise with hospitals clinics and healthcare professionals to obtain medical information and treatment updates.
• Maintain effective communication with healthcare providers to facilitate timely approvals and claim processing.

Administration & Compliance

• Maintain accurate member records and update policy information in internal systems.
• Monitor service turnaround times and ensure compliance with Service Level Agreements (SLAs).
• Ensure compliance with company policies clinical guidelines and Qatar Central Bank (QCB) insurance regulations.
• Maintain confidentiality of medical records and customer information.

Educational Qualification

• MBBS (Bachelor of Medicine Bachelor of Surgery) from a recognized university.

Experience

• 23 years of clinical practice experience after obtaining the MBBS degree.
• Experience in health insurance medical claims utilization review or hospital administration is preferred.

Technical Skills

• Sound clinical knowledge and medical assessment skills.
• Understanding of health insurance policies medical claims and pre-authorization processes.
• Ability to interpret medical reports laboratory results and clinical documentation.
• Proficiency in Microsoft Office applications and healthcare information systems.

Core Competencies

• Excellent customer service and communication skills.
• Strong analytical and problem-solving abilities.
• High attention to detail and accuracy.
• Ability to work under pressure and manage multiple priorities.
• Strong organizational and time management skills.
• Ability to maintain confidentiality and professionalism.
• Team-oriented with excellent interpersonal skills.

Preferred Qualifications

• Experience in a health insurance company or healthcare provider setting.
• Knowledge of ICD-10/CPT coding and medical claims processing is an advantage.
• Fluency in English is required; Arabic is an added advantage.
• Age must be under 45 years.