Talent.com
This job offer is not available in your country.
Officer - Medical Pre Approval / Billing

Officer - Medical Pre Approval / Billing

Global RecruitzPune, IN
8 days ago
Job description

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

Educational Qualifications :

  • Bachelor’s 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.
  • Create a job alert for this search

    Medical Officer • Pune, IN

    Related jobs
    • Promoted
    Billing & Accounts Administrator (AP / AR)

    Billing & Accounts Administrator (AP / AR)

    Telelink Business SystemsPune, IN
    Own Telelink’s end-to-end billing and collections cycle and keep cashflow smooth.You’ll raise accurate invoices, manage accounts payable / receivable, reconcile bank feeds, and provide clean month-en...Show moreLast updated: 6 days ago
    • Promoted
    • New!
    Statistical Programmer

    Statistical Programmer

    SaamaHinjawadi, India
    Statistical Programmer reports to Principal Statistical programmer 3 / Lead, Statistical Programming (L4 (3) or M1), is responsible to work independently on the most of the Mapping activities (SDTM / C...Show moreLast updated: 4 hours ago
    • Promoted
    Medical Insurance Verification / Prior Authorisation Specialist

    Medical Insurance Verification / Prior Authorisation Specialist

    CrammazePune, IN
    Healthcare / Sleep Medicine / DME.We are a high-volume Sleep Specialist office seeking a reliable, organized, and experienced Medical Insurance Verification & Prior Authorization Specialist to join...Show moreLast updated: 27 days ago
    • Promoted
    Purchasing Officer

    Purchasing Officer

    Scry AIpune, maharashtra, in
    Purchasing Officer (SME – Scry AI Products).Years in Procurement, Purchasing, or Vendor Management (experience with AI-driven procurement or digital tools preferred). Scry AI is a research-led enter...Show moreLast updated: 7 days ago
    • Promoted
    Data Officers (Pharmacovigilance)

    Data Officers (Pharmacovigilance)

    ProductLife GroupPune, IN
    ProductLife Group is looking for.Data Officers (Pharmacovigilance).To perform local safety case receipt, processing and data entry, quality control (QC) tracking and ICSR follow up of all safety in...Show moreLast updated: 30+ days ago
    • Promoted
    Guidewire Billing Center Business Analyst

    Guidewire Billing Center Business Analyst

    Zensar Technologiespune, maharashtra, in
    Zensar is Hiring for Guidewire Billing Center Business Analyst Professionals.Location : Hyderabad / Bangalore / Pune / Kolkata. Hybrid Model : 3 days (Work from Office is Mandate).Notice Period : Immediate J...Show moreLast updated: 26 days ago
    • Promoted
    • New!
    Manual Tester Dicom Viewer

    Manual Tester Dicom Viewer

    Arrow Electronicsbaner, India
    We are looking for testers who have already gained initial experience with FORUM or any DICOM viewer testing.The role involves executing both UI and BE related tests. Experience with FORUM, a softwa...Show moreLast updated: 4 hours ago
    • Promoted
    • New!
    Application Developer

    Application Developer

    AccentureHinjawadi, India
    Design, build and configure applications to meet business process and application requirements.Summary : As an Application Developer, you will design, build, and configure applications to meet busin...Show moreLast updated: 4 hours ago
    • Promoted
    • New!
    Application Developer - Telematics

    Application Developer - Telematics

    Bajaj Auto Ltdakurdi, India
    Application Developer – Telematics Experience.Mtech in Electronics (& Telecommunication) / Instrumentation and Control / Electrical Engg. Post graduate DESD from C-DAC will be a plus.We are looking fo...Show moreLast updated: 4 hours ago
    • Promoted
    Guidewire Billing Center Business Analyst (Full-time at a reputed global tech MNC)

    Guidewire Billing Center Business Analyst (Full-time at a reputed global tech MNC)

    HARPPune, IN
    Excellent Domain knowledge on P&C lines of Insurance with expertise in Billings Processes.Strong understanding of Guidewire Billing Center and related modules and functionalities.Skilled in Require...Show moreLast updated: 7 days ago
    • Promoted
    Experienced Billing RCM

    Experienced Billing RCM

    My Care InternationalPune, IN
    Experienced Billing RCM (Physicians / Hospital / Lab).My Care Labs is a leading laboratory specializing in wellness and toxicology testing, committed to providing accurate and timely results to support...Show moreLast updated: 20 days ago
    • Promoted
    • New!
    Territory Sales Manager

    Territory Sales Manager

    CurelinkPune / Pimpri-Chinchwad Area, India
    This enables them to provide better support which is available even out of the clinic, provide better counseling via subject matter experts, and ensure better compliance with timely follow-ups on W...Show moreLast updated: 3 hours ago
    • Promoted
    • New!
    Billing Engineer

    Billing Engineer

    Project Conceptspune, maharashtra, in
    Project Concepts is a leading force in workspace Design & Build, driven by a dynamic team of interior architects.Their commitment to innovation aims to redefine how we perceive and utilize work env...Show moreLast updated: 21 hours ago
    • Promoted
    Medical Biller

    Medical Biller

    SkuadPune, IN
    Medical Biller - Remote 9AM - 6PM EST Time Zone.Primarily remote work with meeting in person on a necessary basis.Verify coverage and eligibility for medical services. Communicate with insurance pro...Show moreLast updated: 30+ days ago
    • Promoted
    Provider Medical Licensing

    Provider Medical Licensing

    medtigoPune, Maharashtra, India
    Only Pune-based candidates should apply.We are looking for a well-organized individual to assist with our licensing initiative. The licensing specialist will be responsible for obtaining and complet...Show moreLast updated: 30+ days ago
    • Promoted
    Ophthalmologist (Medical Data Labeling Specialist)

    Ophthalmologist (Medical Data Labeling Specialist)

    BigRioPune, IN
    Ophthalmologist (Medical Data Labeling Specialist).BigRio is a Boston-based, remote-first technology consulting firm specializing in advanced data and software solutions. We partner with forward-thi...Show moreLast updated: 30+ days ago
    • Promoted
    • New!
    Senior Security Engineer – Medical Device Cybersecurity & Compliance

    Senior Security Engineer – Medical Device Cybersecurity & Compliance

    Arrow Electronicsbaner, India
    Job Title : Senior Security Engineer – Medical Device Cybersecurity & Compliance.Drive end-to-end cybersecurity integration across the medical device product development life cycle, ensuring securit...Show moreLast updated: 4 hours ago
    • Promoted
    • New!
    Data Processing Executive Jobs For 12th Pass Freshers

    Data Processing Executive Jobs For 12th Pass Freshers

    Rb EnterprisesMale, India
    Call Centre / BPO / KPO / ITES / LPO.Show moreLast updated: 4 hours ago