Medical Pre-Approvals Officer

2 weeks ago

Muscat, Muscat, Oman Consulture Search Full time 40,000 - 60,000 per year
ONLY FILIPINO NATIONALS NEED APPLY

Job Purpose:

We are looking for a qualified Executive to join our medical pre-approval team. The role involves evaluating pre-approval requests for medical procedures and treatments, ensuring they meet clinical standards and adhere to the table of benefits and health protocols. The ideal candidate will collaborate with healthcare providers and internal teams to ensure decisions are medically justified, efficient, and customer focused.

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 preapproval 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

Educational Qualifications:

  • Bachelors degree in health science, Pharmacy, Physiotherapy, Nursing, or Dentistry

Experience:

  • Minimum 2 years of relevant experience in medical related field or preapproval function.

Key Skills:

  • Solid understanding of medical treatments, procedures, and terminology.
  • Skilled in critically assessing medical documentation to support informed decision-making.
  • Excellent bilingual verbal and written communication skills 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.

  • Medical Reimbursement Officer

    2 weeks ago

    Muscat, Muscat, Oman Consulture Search Full time 3,120 - 36,000 per year

    ONLY FILIPINO NATIONALS NEED APPLYJob Purpose: We are looking for a qualified Officer to join our medical reimbursement team. The role involves reviewing and processing reimbursement claims for medical services, ensuring they are clinically justified, supported by valid documentation, and compliant with the table of benefits and health protocols. The ideal...

  • Medical Direct Billing

    2 weeks ago

    Muscat, Muscat, Oman Consulture Search Full time 40,000 - 60,000 per year

    ONLY FILIPINO NATIONALS NEED APPLY Job Purpose: We are looking for an Officer Direct Billing to join our clients medical insurance team. The role is responsible for reviewing and processing direct billing claims, ensuring compliance with policy terms, medical necessity, and regulatory standards. The ideal candidate will have strong technical knowledge in the...

  • Medical Direct Billing

    2 weeks ago

    Muscat, Muscat, Oman Consulture Search Full time 30,000 - 60,000 per year

    ONLY FILIPINO NATIONALS NEED APPLYJob Purpose: We are seeking an experienced Senior Officer Direct Billing to join our medical insurance team. The role is responsible for managing and processing direct billing claims, ensuring compliance with policy terms, medical necessity, and regulatory requirements. The ideal candidate will have strong technical...

  • Retail Asset Officer

    6 days ago

    Muscat, Muscat, Oman Majid Al Futtaim Full time 20,000 - 25,000 per year

    JOB TITLERetail Asset Officer | Majid Al Futtaim Properties | Asset Management OmanROLE SUMMARYThe position is mainly responsible to undertake the safety and security of mall customers, merchants, visitors and the staff.ROLE PROFILESecure and clear a 30-meter area, close entrances, and prevent video recording.Direct people to exits, ensure...

  • Public Relation Officer

    1 week ago

    Muscat, Muscat, Oman Dollar Car Rental - AAA Group Full time 2,000 - 3,000 per year

    About the RoleWe are seeking an experienced and detail-oriented Public Relations Officer (PRO) to join our Administration team in Oman. The ideal candidate will manage all government-related tasks, legal procedures, vehicle registrations, and compliance activities while ensuring smooth business operations.Key ResponsibilitiesHandle all fleet-related...

  • Collection Officer- Remedial

    2 weeks ago

    Muscat, Muscat, Oman Tawteen Full time

    Strategic:Effectively manage portfolio delinquency to support the management mandate.Develop and improve methods of collection, restructure/reschedule, and exit plans in terms of quality and efficiency.Operational:Maximize profitability by recovering the maximum amount of delinquent debt, while ensuring delinquent cases are handled appropriately and as per...

  • Health Representative Oncology

    6 days ago

    Muscat, Muscat, Oman Pfizer Full time 30,000 - 60,000 per year

    POSITION SUMMARY:The Health Representative – Hybrid position is responsible for maximizing the sales of products through the different sales & promotion activities within a certain geographic territory leveraging digital channels as well as F2F, to achieve set target objectives.His/Her promotional orientation (i.e., Rx sales targets) will be to create...

  • Senior Sales Executive

    1 week ago

    Muscat, Muscat, Oman Kinetic Business Solutions Full time 60,000 - 120,000 per year

    Kineticis working with a leadingMedical Devicecompany who are hiringSenior Sales Executiveto be based inMuscat.***Please take the time to read the job description, you must meet all the criteria set out below for your application to be considered. We do check all applications and suitable candidates will be contacted within 5 working days. If you are not...

  • chief finance officer

    6 days ago

    Muscat, Muscat, Oman AJYAL HR Solutions & Services Full time 90,000 - 120,000 per year

    Job Purpose:The CFO will be responsible for overseeing the financial operations of the company, guiding its financial strategy, planning, and maintaining its fiscal stability. This role involves managing financial risks, ensuring compliance with regulatory requirements, and providing strategic guidance to support long-term growth and profitabilityJob...

  • Liquid Hydrogen Expert

    2 weeks ago

    Muscat, Muscat, Oman Wood PLC Full time 60,000 - 120,000 per year

    Remarkable people, trusted by clients to design and advance the worldWood is recruiting for a Liquid Hydrogen Expert to join its Projects team focusing on delivering across FEED and Detail design scopes of work. In this role, you will be responsible to execute the activities and processes associated with Business Development of a Liquid Hydrogen opportunity,...