Medical Approval Officer

métier – Strategic HR Solutions is hiring a Medical Approval Officer – OP & IP for one of our clients in the UAE.We are looking for a medical professional with experience in medical approvals, pre-authorizations, utilization review, or insurance claims to assess and process OP/IP cases in line with clinical guidelines and policy terms.

Key Responsibilities

Review OP/IP pre-authorization requests and supporting medical documents.Assess medical necessity, diagnosis, treatment plans, and clinical requirements.Approve, pend, or reject requests based on policy and medical guidelines.Coordinate with hospitals, doctors, insurers, and internal teams.Escalate complex or high-cost cases when required.Maintain accurate case documentation and ensure compliance with internal and regulatory requirements.

Requirements

MBBS, BDS, Nursing, Allied Health, or relevant healthcare qualification preferred.2–5+ years of experience in medical insurance, hospital insurance desks, utilization review, or claims.Hands-on experience in OP/IP approvals and pre-authorizations.Knowledge of medical necessity, treatment protocols, policy benefits, and exclusions.UAE healthcare/insurance experience is an advantage.Medical Coding, Health Insurance, Claims Management, or Clinical Audit certification is a plus.