Associate, Preauthorization

Sukoon Insurance; Dubai; On-site; AED 180,000 - 300,000; Full time

Job summary

Sukoon Insurance in Dubai seeks a Medical Audit specialist to oversee PAR administration, fraud controls, and adherence to regulatory guidelines. You will manage case reviews, ensure timely resolutions, and support 24/7 PAR operations.

Ideal candidates hold a medical degree with health insurance experience, strong English communication, and knowledge of coding standards. Arabic language skills are a plus and a dynamic, compliant work environment is offered.

Qualifications

• Medical degree or clinical qualification with exposure to health insurance operations.
• Proven experience in medical auditing, PAR, claims adjudication, and FWA control.
• Solid understanding of healthcare systems, policies, and regulatory requirements.
• Excellent communication skills in English; Arabic is an advantage.

Responsibilities

• Coordinate with providers for case management and cost control.
• Handle customer queries and ensure adherence to SLAs and turnaround times.
• Assist in running the PAR unit on a 24/7 basis and pre-authorization processes.
• Conduct onsite audits for suspected fraudulent practice and report to FWA/Network.
• Maintain MIS, quality controls, and SOPs; monitor unit KPIs and SLAs.

Skills

Medical auditing

PAR / pre-authorization

Claims adjudication

FWA control

Policy knowledge

Regulatory compliance

English communication

Arabic skills

Education

Medical degree or clinical qualification

Tools

MS Office Suite

Healthcare claims systems

MIS reporting tools

Job description

• The job holder will be responsible for medical audit, PAR administration, control of fraud / abuse and assurance of customer service.
• Receive intimation from Provider through over regulatory portal/e-mail (non-network providers) along with relevant medical reports.

Key Accountabilities:

• Coordinate with providers for case management and cost control.
• Ensure appropriate handling of the customer queries and concerns and achieving FTR.
• Ensure adherence to agreed SLAs for OP/IP Adjudications.
• Address client/broker and provider queries.
• Escalate customer issues and concerns where the timely resolution is not being achieved in light of the laid out policy and turn around time.
• Assist in the running of the PAR unit on a daily 24/7 basis.
• Ensure adherence to unit KPIs and internal and external SLAs.
• Assist in implementation of medical pre-approval processes and regulatory guidelines.
• Conduct onsite visits for audit of suspected cases of fraudulent practice by providers and highlight to FWA and Network team.
• Review and audit medical approvals and conclude pending approvals.
• Ensure implementation and maintenance of relevant management information systems, quality controls and SOPs.

Qualifications:

• Medical degree or relevant clinical qualification with strong exposure to health insurance operations.
• Proven experience in medical auditing, pre-authorization (PAR), claims adjudication, and fraud/waste/abuse (FWA) control.
• Solid understanding of healthcare systems, insurance policies, and regulatory requirements.
• Strong decision-making ability with demonstrated capability to assess and authorize eligible medical cases.
• Excellent communication skills in English (written and verbal); Arabic language skills are an advantage.
• Proficient in IT systems, including MS Office Suite, healthcare claims management systems, and MIS reporting tools.
• Knowledge of medical coding standards (e.g., ICD, CPT) is highly desirable.
• Experience in business process improvement, including process mapping, workflow documentation, and optimization initiatives.
• Familiarity with quality improvement methodologies such as Lean, Six Sigma, or similar frameworks.
• Ability to manage multiple priorities in a 24/7 operational environment while ensuring adherence to SLAs, KPIs, and regulatory guidelines.