Pre-Certification Administrator

Job description / Role

On behalf of a client, we are currently looking for Pre-certification Administrator to be placed in their office in Dubai

This position will be responsible for preparing and processing pre-certification requests for the assigned portfolio.
Other duties will include handling insured members’ queries related to pre-certifications, providers’ inquiries (email, fax, phone) and contractual questions, as well as activities related to the management of the portfolio.

DESCRIPTION OF TASKS

• Process pre-certification requests for the assigned portfolio
- Receive requests for pre-certification received either by phone, e-mail, Fax, or handed by hand.
- Check eligibility of the insured
- Check premium status
- Verify eligibility of expenses as per policy requirements and direct-payment guidelines
- Issue letter of guarantee (LOG)
- Issue verbal approval (VA) codes
- Medical review, prior approvals (for medical doctors only).
• Coordination between administrators for approvals according to policy terms and conditions.
• Handling pre-approval from Healthcare providers and clients.
• Referring insured members to second opinion when required (for medical doctors only).
• Manage requests according to authority limits.
• Report suspected fraud cases to supervisors.
• Reply to insured members inquiries about procedures to be followed or status of their pre-certification file via telephone, fax, e-mail
• Ensure the best customer service to providers, insured, coordinators, brokers by providing 24 hours helpline.
• Report any complaint encountered to Pre-certification Supervisor, Pre-certification

Requirements

EDUCATION
• Level of study/Degrees: Bachelors degree with medical background.
• Language skills: English (other languages appreciated, in particular French and/or Arabic).
• Computer skills: Working knowledge of office automation tools and internet.

PROFESSIONAL EXPERIENCE
• Optional experience: Previous experience in the insurance industry or previous experience in the medical field

NECESSARY SKILLS AND ABILITIES
• Ability to communicate effectively and professionally in English (written/oral) and/or French, Arabic would be an advantage.
• Keen attention to detail
• Ability to multi-task and adapt to various situations
• Strong organizational skills with strengths in prioritization and efficiencies
• Strong customer service skills
• Ability to work within a team environment
• Knowledge of how to locate and interpret various company health insurance policies.
• Analytical
• Good listening skills/ Interpersonal skills
• Proactive attitude
• Ability to sympathize and reassure clients
• Diplomatic
• Ability to work under pressure

About the Company

Transguard Workforce Solutions delivers Professional Contract Staffing (also known as Employee Outsourcing) within the UAE.

Our Workforce Solutions include:

• Delivering Sourcing and Recruitment Solutions for Clients in need of identifying Contract or temporary Staff.

• Providing a complete end to end Staffing Solution which includes Visa Sponsorship, HR Management, Employee Welfare & Payroll Services.

• Transitioning Contract Staff from other staffing providers to Transguard while remaining compliant with UAE Labour and Immigration Laws.

Transguard Workforce Solutions currently employ over 2000+ Staff from over 70 different nationalities. Across the Group, we payroll over 70,000 employees monthly.