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 preferredInsurance qualification/background is essential in similar roleMinimum working experience 4-5 years (1-2 years in UAE) in preapproval roleCandidate must have good exposure in preapproval and PBMCall Centre skills are mandatoryCandidate 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.