Associate, Preauthorization (Contract)

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. Important Notes: - This is a 1-year contract position. - The role operates on a shift-based schedule, and candidates should be flexible to work assigned shifts. - This position is aligned with entry-level compensation and benefits. - Arabic language proficiency is an advantage, as the role may involve interaction with Arabic-speaking customers/stakeholders.