Position Title: Call Center and Pre-Approval Sr. Officer
Closing Date: 30/09/2022
Job Summary
Pre-approval process summary
Receiving the request for a medical procedure through the email from the provider or directly from the member him/herself – Reviewing the patient’s medical report to ensure that all necessary information is present – Reviewing the patient’s expenditure making sure his/her request is within the boundaries of the benefit policy – Issuing the pre-authorization form or the rejection document detailing the relevant reasons.
Pre-approval staff require to work closely with the Benefits Verification Team to validate patient’s insurance plans, prescriptions and eligibility. Job responsibilities include ability to read prescriptions, convert prescriptions into authorizations and interpret medical policies. Prior Authorization Officers are responsible for contacting clinics and hospitals offices to validate prescriptions, obtain clinical documentation and initiate prior authorizations through insurance plans.
Call center job summary
Receiving Task about to receiving the client’s call – Enquiring about the client’s enquiry/complaint – Relaying the enquiry/complaint to the relevant department – Following up with the client to ensure that the service has been provided in an optimal manner.
Call Center staff require demonstrated excellence in achieving company values and successfully assisting customers. Strong problem solver with the multitasking ability to handle several customer needs with ease.
Job Description:
1. Answer inbound calls as well as assist customers who have specific inquiries.
2. Queries may range between coverage questions, network location and medical questions.
3. Receive requests from Healthcare providers (Hospitals, Laboratories, pharmacies…) and reply with approval decision (approved or rejected).
4. Participate in committees, work groups, and/or process improvement teams that improve patient satisfaction.
5. Review all medical approvals & claims.
6. Issuance of necessary medicines and medical approvals - surgeries - X-rays - tests that require it
Medical solving customer problems.
Main functions and responsibilities:
1. Assist UIC members, providing successful solutions in a polite manner using active listening to ensure customer retention.
2. Received approval requests by mail, and handle the approval process carefully in time frame of approval dept.
3. Creating, monitoring and tracking approval process for medical, dental, vision...etc.
4. Contact hospitals, clinics to obtain required information if required.
5. Record all customer names and contact information in an order to follow up complaints, Escalated customer complaints and/or calls to concerned dept.
6. Support network team in pricing procedure if required
7. Supported the management team in identifying operational opportunities for continuous improvement.
8. Performed other duties as assigned by management team
9. Follow up with vendor supply medicine and billing process
10. Check monthly utilization report for chronic and update concerned member accordingly
11. Update monthly report required for chronic medication procedure
Requirements – Skills, Abilities, and Knowledge :
1. Post Graduate in Accounting. Possession of internationally recognized accounting/ auditing qualifications like CPA, CIA. CBA, etc, or related field of study from a recognized Institution>
2. Strong knowledge of standards, procedures, and general auditing policies
3. Possess great interest in working with different people
4. Strong ability to supervise and train employees, including organizing, prioritizing, and scheduling of work assignments
5. Effective and explicit communication skills in both oral and written forms
6. Ability to analyze and solve problems relating to auditing and related disciplines
7. Ability to foster a friendly work environment for team members
8. Deep knowledge of the processes of the courts and legal documentation
9. Computer skills: possess knowledge of Microsoft Suites, including Microsoft Word, Excel, and PowerPoint; and also proficiency in the use of audit and accounting software
10. Strong organizational skills, which relates to the prioritizing of workloads and showing a great level of resilience and calmness even when under pressure
11. Demonstrate a high level of integrity to be able to adhere to regulations and its total compliance
12. Strong ability to take initiatives and make sound decisions.
Required Experiences:
Minimum 15 years auditing experience including at least 5 years in senior position, with extensive knowledge and experience in all financial operations and rules & regulations pertaining to Insurance industry.
Applications should be emailed to This email address is being protected from spambots. You need JavaScript enabled to view it.
Please quote “Job Title” on the Subject Line.
