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
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
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