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

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.