Healthcare Pre-Approval Specialist (ePAR/PBM)

Sukoon Workplace Savings Solutions Limited; Dubai; On-site; AED 120,000 - 180,000; Full time

Job summary

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

Responsibilities

• 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

Skills

Medical knowledge

Communication skills

English proficiency

Arabic proficiency

MS Office

Health claim system

Medical coding

Process optimization

Lean Six Sigma

Education

Paramedical/Nursing degree

Medicine degree preferred

Tools

MS Office

Health claim system

MIS tooling

Job description

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.