Medical Board Assistant

Job description / Role

Main responsibilities (minimum of 3 key points in category please) will include:

Key Responsibilities
• Adjudicating and Processing insurance pre-approvals in a timely and accurate manner following Claims policy. Within the agreed TAT per line of business
• Providing preapproval for medical claims based on medical eligibility and policy terms.
• Implement cost containment through Guidelines and proper medical adjudication.

Operational & technical responsibilities
• Sound knowledge of all medical insurance and guidelines
• Ability to understand the different aspects of the Healthcare Platform to be able to direct queries to the relevant parties where necessary.
• Requires a basic understanding of the reasons for inclusion/exclusion of certain treatments or conditions.
• Sound knowledge of regulations from a regulatory authority.
• Considerable degree of independent thought and judgment to evaluate medical decisions on an objective basis.
• Decide on pre-approval based on medical necessity and policy terms & conditions.
• Reporting of provider abuse if it is found to be recurrent as part of the cost-containment strategy of the health care operation.
• Individual quality monitoring

• Essential: 2-3 years’ experience preferably within the health care industry.
• Medical / Nursing qualification
• Flexibility to work in 24/7 Shifts
• Desirable: Sound medical knowledge.
• Good analytical skills
• Preferably with Medical insurance background
• Preferably worked in approvals department
• Customer-focused
• Strong communication (verbal & written)
• Ability to work effectively within a team environment
• Highly motivated and proactive
• Results-driven and solution-orientated

About the Company

Propel Consult delivers a service in step with the needs of both our client companies and candidates. Our ability to add value to all levels of recruitment stems from our wholehearted belief in providing a professional service to both parties.

We have built relationships with many leading indigenous and mulitnational organisations throughout the Middle East and internationally in countries such as UAE, Qatar, Saudi Arabia, Oman, Bahrain, Kuwait, Egypt and many more.

Concentrating our resources has created 5 distinct specialist divisions:

• Banking & Finance
• Human Resources
• Oil & Gas
• Construction
• Architecture & Engineering