✨ AI Summary
The Associate, Preauthorization position at Sukoon Insurance is a 1-year contract role responsible for processing ePAR and PBM cases via calls and emails. Key responsibilities include reviewing and adjudicating pre-approval requests according to policy terms and clinical guidelines, issuing accurate pre-approvals, and providing excellent customer service to pharmacies, providers, and customers. The role requires effective communication and collaboration with colleagues and supervisors.
Candidates must possess a Bachelor's degree in paramedical or nursing, with a preference for medical graduates, and have a strong insurance background. A minimum of 4-5 years of preauthorization experience, including 1-2 years in the UAE, is required. Mandatory skills include decision-making, medical coding, proficiency in MS Office and health claim systems, and knowledge of business process design. Excellent verbal and written English communication is essential, and Arabic proficiency is an advantage. The position operates on a shift basis and offers entry-level compensation and benefits.
Requirements
The Associate, Preauthorization role requires a Bachelor's degree in paramedical or nursing, with a preference for medicine graduates. Essential qualifications include an insurance background and 4-5 years of experience in a preauthorization role, with 1-2 years specifically in the UAE. Strong call center skills, knowledge of medical coding, proficiency in MS Office and health claim systems, and understanding of business process design and performance improvement methodologies are mandatory. Excellent communication skills in English are required, with Arabic being preferable.
Description
The jobholder will be responsible for processing ePAR and PBM cases thru calls and emails.Responsibilities:Ensure timely review of ePAR and PBM cases and process as per prescribed guidelines and protocols. Responsible for issuing accurate Pre-approvals to the providers and deliver excellent customer service. Review pre-approval request and adjudicate as per defined policy terms and conditions/clinical/regulatory guidelines.Answer calls and emails from pharmacies, providers, and customers using exemplary customer service skills.Review clinical data matching it against specified medical terms and/or diagnosis /procedure codes and follow established procedure for authorizing preapproval request.Establish effective rapport with other employees and supervisor and maintain cooperative working relationship; actively support departmental activities.Skills Required:Medically educated and trained with good overall business experience focusing on health insurance.Decision making skills to be able to authorize eligible cases.Very Good communication skills, verbal and written in English (required) and Arabic (preferable).IT skills including MS Office suite, health claim system, MIS.Medical coding knowledge.Business process design, reengineering, optimization and documentation (workflow, process maps).Lean, Six Sigma or other performance/quality improvement methodologies.Qualifications:Bachelor's degree in paramedical or /nursing. Medicine graduate would be preferredInsurance qualification/background is essential in similar roleMinimum working experience 4-5 years (1-2 years in UAE) in preapproval roleCandidate must have good exposure in preapproval and PBMCall Centre skills are mandatoryCandidate must possess local market know-how and must be well versed with regulatory guidelines.Important Notes:This is a 1-year contract position.The role operates on a shift-based schedule, and candidates should be flexible to work assigned shifts.This position is aligned with entry-level compensation and benefits.Arabic language proficiency is an advantage, as the role may involve interaction with Arabic-speaking customers/stakeholders.