Officer - Medical Pre-Approvals

3 days ago

Muscat, Muscat, Oman métier - Strategic HR Solutions Full time 100,000 - 150,000 per year

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

Location: Muscat, Oman

Industry: Insurance/Healthcare

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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