Authorization Officer

Medical Insurance Jobs
Abu Dhabi
March 2, 2025
Temporary
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Job Description

Job Title: Authorization Officer (Temp)

Location: Abu Dhabi

Responsibilities:

  • Perform claims adjudication and reconciliation processes.
  • Provide patient care navigation incl. appropriate (pre-) authorisations of medical services and medical case management.
  • Administer cross-border healthcare operations.
  • Support further development of automation processes where sensible while having ownership of the authorisation auto-compute engine, with overall accountability for the combined rules engine lying with the Head of Medical Operations.
  • Act as an inhouse TPA management for the Domestic Government relation project expansion.
  • Identify complex high-cost cases with potential for savings and transmit to case management.
  • Evaluate medical necessity of requested service according to medical data provided and accurately code service description stated on the prior authorisation requests, based on accepted medical coding rules, medical guidelines and policy’s schedule of benefits
  • Ensure that proper documentation of the data including business decisions are correctly done on the system with focus on accuracy and efficiency and quality
  • Ensure that medical ethics are always applied and respected while performing duties
  • Constantly work on improving TAT and relevant functional/personal competencies
  • Report suspected cases of fraud and abuse by healthcare providers to respective Supervisor
  • Ensure cases needing Case Management intervention are escalated based on communicated criteria
  • Handle changes in the workload flow from healthcare providers in terms of time, quantity and type of prior authorisation requests received with clear focus on quality and set target
  • Process high cost pre-authorisation request in line with the high cost authority matrix
  • Support company’s decisions while keeping company professionally represented

Key Requirements:

  • Experience in medical unit of a health insurance company or third-party administrator (TPA) is a plus.
  • Certification in the medical coding systems is a plus.
  • Basic analytical, execution, problem solving and decision-making skills.