Medical Approval Manager

Job description / Role

The Medical Approval Manager is responsible for managing, planning and directing the Medical Approvals and Customer Service teams in accordance with company quality standards whilst ensuring compliance with GCC, international and US regulations. The incumbent will be reviewing and approving payment on pre-approvals received from providers on medical cases.

Main functions and responsibilities:
- Plan and direct the operation of Medical Approval Team in accordance with the department objectives.
- Prepare department’s yearly budget, plans and suggest recommendations.
- Analyze prior-approval requests, negotiate the cases with the providers when necessary and approve payment against Pre-approvals on medical cases
- Ensure that medical cases and customers queries are solved in accordance with Company quality standards in order to reach customer medical necessity and satisfaction.
- Consult the Global Clinical Team Experts for complicated medical cases.
- Cascade Company objectives to the team leaders, ensure proper communication on new projects and new services; facilitate the workflow between the Medical Approval Department and all other departments.
- Review and analyze Medical service activities and data in order to support planning and risk management and to improve service utilization.
- Prepare monthly statistical reports to VP Medical related to department operation, budget and cost containment, customer and provider complaints and medical cases.
- Report regularly the team’s performance to VP Medical.
- Appoint Team Leaders, assign responsibilities, set objectives and assess their performance to measure achievements against these objectives.
- Coach, develop and guide the Team Leaders.
- Ensure that Company core competencies, values and policies are implemented across the Department teams.
- Support the Team Leaders in the process re-engineering and update.
- Miscellaneous tasks within the scope of work, as assigned by the direct manager.

Requirements

- Doctor degree is mandatory
- Business Management Certificate or equivalent
- 8 years’ experience; preferably in health insurance field
- Microsoft Office: proficiency in Excel & word
- Analytical thinking
- Costumer focus
- Quality orientation
- Problem solving
- Managerial skills
- Leadership skills
- Organizational skills
- Communication Skills

About the Company

Established in 1996, Clarendon Parker Bahrain is an International Recruitment Specialist Consultancy based in Bahrains Seef Business District. We specialise in mid to senior level professional, managerial, technical recruitment and staffing solutions in Bahrain and beyond. Our multinational team of consultants are experienced professionals within the fields they represent. Each consultant brings strong industry links and knowledge to better understand your business requirements. We know the market and we know our candidates!

Our team of dedicated consultants specialise in the following industries:

Accounting, Finance & Banking Logistics & Customer Service Secretarial & Administration Human Resources & Recruitment Engineering & Construction IT/Telecom Marketing & PR Oil and Gas

The current range of services includes permanent and temporary recruitment, recruitment advertising campaigns, employee satisfaction surveys, state-of-the-art web-based recruitment technology and HR consulting services relating to recruitment processes and activities.