Precertification Officers

Summary
The Precertification Officer is responsible for obtaining prior authorizations
for all procedural orders by successfully completing the authorization process
with all commercial payers with high efficiency and within the agreed
turnaround time to maintain the team KPIs.

Main Tasks

• Assesses approval of medical approvals as well as policy use.


• Checks particular treatment plan is necessary for the patient.


• Inputs verbal and written claims approvals regularly.


• Decides approvals as per policy conditions.


• Assess high cost claims and provide decision on high cost and complicated cases.


• Provides clear feedback on queries from call Centre team.


• Provides clients an understanding of any declined medical claims.


• Coordinates workflow & meet deadlines.


• Evaluates claims concerning eligibility.

KPIs of Primary Responsibility

Claims Officer- Precertification
Productivity ‎30%
Meet daily Precertification productivity target according to claims
type/tenure.

Service level ‎30%
Adjudicate Outpatient Precertification on First in First out basis.
Maintain Productivity TAT of ‎85% in ‎10 minutes and ‎98% within 1st hour and
immediate for
Emergency/ VIP

Quality ‎30%
Claim adjudication With NO Financial or Potential financial Error
Claim adjudication With NO Technical Error following the publish adjudication
rules.

Attendance and punctuality ‎10%
Adherences ‎100% to Schedule and Punctuality.

Main Requirements
* Bachelors of Medicine - Pharmacy.
* ‎2+ years Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus).
* Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.

Job Level:
Professional
Location:
Dubai, AE
Area of Expertise:
Operations
Unit:
Allianz Partners
Employing Entity:
NEXTCARE Claims Management LLC
Job Type:
Full-Time
Remote Job:
Hybrid working
Employment Type:
Permanent
ID:
‎36201