Officer - Medical Pre Approval / Billing

Hiring for a reputed Insurance company based at Oman

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

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