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Officer - Medical Pre-Approvals

métier - Strategic HR SolutionsMuscat, Muscat Governorate, Oman

4 days ago

Job description

Job Position : Officer – Medical Pre-Approvals (Medical Insurance)

Employment Type : Full-time

About the Role

métier - Strategic HR Solutions is hiring an Officer – Medical Pre-Approvals on behalf of one of our clients in the insurance sector. The role is responsible for reviewing and adjudicating medical pre-approval requests, ensuring medical necessity, compliance with policy guidelines, and adherence to regulatory requirements. The ideal candidate will have a healthcare background with experience in medical claims or pre-approvals.

Key Responsibilities

Review and adjudicate medical pre-approval requests and assess clinical necessity
Analyze clinical documents and patient history to determine the appropriateness of proposed treatments
Communicate with healthcare providers to obtain clarification and additional documentation when required
Provide clinical recommendations based on established medical guidelines and best practices
Ensure adherence to insurance regulations, internal protocols, and medical table of benefits
Analyze and evaluate pre-approval trends from medical providers and detect abnormalities
Ensure strict adherence to regulatory requirements and company pre-approval policies
Resolve disputes related to medical pre-approvals in a fair, evidence-based manner

Requirements

Bachelor’s degree in Health Science, Pharmacy, Physiotherapy, Nursing, or Dentistry

Minimum 2 years of relevant experience in a medical-related field or pre-approval function

Solid understanding of medical treatments, procedures, and terminology

Skilled in critically assessing medical documentation to support informed decision-making

Excellent bilingual communication skills (verbal and written) for effective collaboration with healthcare providers and team members

High accuracy in evaluating claims and ensuring adherence to policies

Proficient in managing complex or ambiguous cases using sound clinical judgment

Please note that only shortlisted candidates will be contacted for further discussion.

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Officer • Muscat, Muscat Governorate, Oman