Clinical Insurance Officer

Ghobash Group; Abu Dhabi; On-site; AED 120,000 - 200,000; Full time

Job summary

A healthcare organization in Abu Dhabi is seeking a Clinical Insurance Officer to manage insurance processes for home healthcare patients. Responsibilities include obtaining approvals, verifying insurance coverage, and ensuring compliance with standards. The ideal candidate should have a Bachelor of Nursing and 2 years of relevant experience. This is a full-time position with no remote work options.

Qualifications

• Minimum of 2 years experience in a similar role.
• Experience with pre-authorizations and insurance claim documentation.
• Ability to coordinate with medical staff and insurance companies.

Responsibilities

• Manage insurance pre-authorizations and renewals for homecare services.
• Verify patient insurance eligibility and coordinate approvals with insurers.
• Prepare and submit necessary reports to insurance companies.

Skills

Advanced understanding of medical terminology

Knowledge of insurance processes

Strong communication skills

Education

Bachelor of Nursing

Job description

Summary

The Clinical Insurance Officer is responsible for managing all insurance-related processes for home healthcare patients including pre-authorizations renewals and claim documentation. The role ensures that all clinical and administrative requirements are met in compliance with payer guidelines Department of Health (DOH) standards and internal policies.

Roles & Responsibilities

• Obtain monitor and renew insurance pre-authorizations for all homecare services (e.g. nursing physiotherapy medical and multidisciplinary care).
• Verify patient insurance eligibility and coverage before initiating or renewing services.
• Coordinate with insurance companies and third-party administrators (TPAs) to secure approvals and address pending or rejected requests.
• Liaise with physicians and clinical staff to complete and submit all required medical reports and treatment plans.
• Ensure all insurance forms including DAMAN Forms (PAFs progress notes medical reports) are properly signed stamped and compliant with DOH and payer requirements.
• Track authorization validity to prevent service interruptions for active patients.
• Score medical condition and services for new and established patients.
• Follow up with insurance company regarding required reports or information.
• Determining the correct codes for patient records
• Prepare all reports and documents required by insurance company to grant pre-approval as (collection and arrange the reports face to face consent form license of nurses physiotherapy & Doctor nursing care plan physiotherapy plan and assessment Scoring grid)
• Review clinical documentation to ensure it supports medical necessity for services billed to insurance.
• Verify that patient records including Periodic Assessment Forms (PAFs) and treatment notes align with the approved authorization scope and duration.
• Identify incomplete or inconsistent documentation and coordinate with clinicians for prompt correction
• Keeping track of patients hospital admission ER visits and discharges.
• Prepare monthly report as Patient movement daman allocation admission and discharge
• Daily submission of staff capacity to daman.
• Prepare and submit JAWDA KPI report and act as JAWDA KPI data collector.
• Collect and save all KPI reports.
• Perform other duties as assigned by management.

Qualifications

• Bachelor of Nursing
• 2 years experience in a similar role
• Advanced understanding of medical terminology and administration processes

Remote Work

No

Employment Type

Full-time