Medical Case Coordinator

NATIONAL GENERAL INSURANCE CO (P.J.S.C); Dubai; On-site; AED 100,000 - 167,000; Full time

Job summary

National General Insurance Co (P.J.S.C) in Dubai seeks a dedicated professional to manage pre-approvals and authorizations for insured members. You will liaise with medical providers and patients, ensuring policy terms are met and timely responses are provided.

The role involves reviewing case records, resolving pharmacy rejections, and processing monthly claims for pharmacy and outpatient clinics. Insurance experience is preferred and a Bachelor’s degree in Pharmacy or Nursing is required.

Qualifications

• Experience in handling pre-approvals/pre-authorizations, reconsiderations, or appeals.
• Strong communication with insured members, providers and internal teams.
• Excellent customer service and ability to respond quickly to inquiries.

Responsibilities

• Provide approvals through online system (DHPO), emails and calls to medical providers based on medical necessity and policy wordings.
• Coordinate between Insurer, patient and provider.
• Handle phone calls and written inquiries related to pre-approvals/pre-authorizations, reconsiderations, or appeals.
• Perform comprehensive case record reviews to verify required data and documentation.
• Handing pharmacy rejections and approving when aligned with indications and policy wordings.
• Process pharmacy and outpatient clinic claims at month-end.

Skills

Customer service

Communication

Attention to detail

Education

Bachelor of Pharmacy

Bachelor of Nursing

Tools

DHPO system

Job description

Providing approval of services for the insured member through DHPO, email and PBM, over riding of rejected medication if falls under policy t&c and if clinically justified.

Providing excellent customer service through responding swiftly to queries from insured member, medical provider .

1. Provide approval through online system(DHPO), emails and call to Medical provider according to medical necessity and as per policy wordings.

2. Coordinate between Insurer, patient and provider.

3. Handles phone calls and written inquiries related to requests for pre-Approvals/pre authorizations, reconsiderations, or appeals.

4. Performs a comprehensive review for the record to assure thepresence of all component parts such as patient and record identification, signatures and dates where required and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.

5. Handing pharmacy rejection and approving the same if matches with indications and policy wordings.

6. Processing pharmacy and op clinics claims at the end of the every month.

Desired Candidate Profile

Qualifications:Education : Bachelor of Pharmacy/Bachelor of NursingExperience : Insurance experience is preferred