Associate, Preauthorization (6 Months Contract)

Sukoon Workplace Savings Solutions Limited; Dubai; Sur place; AED 120 000 - 180 000; Plein temps

Résumé du poste

Sukoon Workplace Savings Solutions Limited is seeking a health-insurance preapproval specialist to process ePAR and PBM cases via calls and emails. You will review data, adjudicate per policy, and ensure accurate preapprovals while delivering excellent customer service.

Required are a paramedical/nursing degree (medicine degree preferred), UAE experience, and strong English communication; Arabic preferred. Prior call center exposure and knowledge of regulatory guidelines are essential.

Qualifications

• Bachelor’s degree in paramedical or nursing; medicine degree preferred
• Insurance qualification/background essential for similar role
• Minimum 4–5 years experience (1–2 years in UAE) in preapproval role
• Candidate must have good exposure in preapproval and PBM
• Call Centre skills are mandatory
• Candidate must possess local market know-how and be familiar with regulatory guidelines

Responsabilités

• Process ePAR and PBM cases via calls and emails according to guidelines
• Review pre-approval requests and adjudicate per policy/clinical/regulatory terms
• Answer calls and emails from pharmacies, providers and customers with strong service
• Review clinical data and match against medical terms/diagnosis or procedure codes for preapproval
• Establish rapport and support department activities

Connaissances

Medical knowledge

Communication skills

English proficiency

Arabic proficiency

MS Office

Health claim system

Medical coding

Process optimization

Lean Six Sigma

Formation

Paramedical/Nursing degree

Medicine degree preferred

Outils

MS Office

Health claim system

MIS tooling

Description du poste

The jobholder will be responsible for processing ePAR and PBM cases thru calls and emails.

Responsibilities:

• Ensure timely review of ePAR and PBM cases and process as per prescribed guidelines and protocols. Responsible for issuing accurate Pre-approvals to the providers and deliver excellent customer service. Review pre-approval request and adjudicate as per defined policy terms and conditions/clinical/regulatory guidelines.
• Answer calls and emails from pharmacies, providers, and customers using exemplary customer service skills.
• Review clinical data matching it against specified medical terms and/or diagnosis /procedure codes and follow established procedure for authorizing preapproval request.
• Establish effective rapport with other employees and supervisor and maintain cooperative working relationship; actively support departmental activities.

Skills Required:

• Medically educated and trained with good overall business experience focusing on health insurance.
• Decision making skills to be able to authorize eligible cases.
• Very Good communication skills, verbal and written in English (required) and Arabic (preferable).
• IT skills including MS Office suite, health claim system, MIS.
• Medical coding knowledge.
• Business process design, reengineering, optimization and documentation (workflow, process maps).
• Lean, Six Sigma or other performance/quality improvement methodologies.

Qualifications:

• Bachelor’s degree in paramedical or /nursing. Medicine graduate would be preferred
• Insurance qualification/background is essential in similar role
• Minimum working experience 4-5 years (1-2 years in UAE) in preapproval role
• Candidate must have good exposure in preapproval and PBM
• Call Centre skills are mandatory
• Candidate must possess local market know-how and must be well versed with regulatory guidelines.