Medical Consultant-Medical Authorization IP

Full Time
Dubai
Posted 6 months ago

Job Purpose:

The job holder will be responsible for handling Pre-authorization requests with assuring excellent customer service. Provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of the cases.

Roles and Responsibilities

  • Answer all incoming calls related to Inpatient authorizations following the Company guidelines and protocols. In case of call queues handle OP calls as well
  • Reviews case records and reports, collects and analyzes data, evaluates client’s medical status and defines needs and problems in order to provide proactive case management services
  • Handle incoming client/provider emails for ongoing/escalated IP cases
  • Facilitate and complete the administrative and demographic portion of the Pre-authorization screen module for each request received from the provider/ clients / members
  • Handles escalated calls from Executives of the Medical Authorization OP and IP team that require an intervention and ensure a resolution is achieved.
  • Authorize medical treatment and associated diagnostic testing on assigned claims as allowed by various insurance policies
  • Work the Case Managers and Sr. Medical Authorization Consultants who in turn will liaise with medical providers and suggest cost effective treatment alternatives, when appropriate.

ORGANIZATIONAL DUTIES

  • Ensure Service Level Agreements (SLA) of the client is met for based on the contractual agreement.
  • Maintain a good knowledge of service provided by Neuron, including Medical insurance policies and the network of hospitals, clinics and pharmacies provided
  • Continuously strive to improve the processes and ensure high level of customer satisfaction and meet all the service level agreements set by our clients and the company.
  • Comply with established Best Practices

Qualifications:

  • Graduate – Medical Qualification (MBBS Doctor)
  • Familiarity with medical terminologies
  • Excellent command over English (both verbal and written)
  • Strong Customer Service Skills
  • Ability to work on your own initiative and as part of a team
  • Ability to prioritize work
  • Problem solving skills and ability to generate solutions
  • Prior experience in Insurance industry preferably TPA

Job Features

Job CategoryCall Center, Clients Support
Job IdMAY 001 MAIP/CS/ORG
Career LevelMid Level
Years of ExperienceMinimum 2 Years

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