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Medical Board Assistant
4 days ago
**Company**
Our client is one of Saudi Arabia’s and Bahrain’s leading companies in the field of facility management, construction, trading and investment. They are currently looking to hire a **Medical Board Assistant **to be based in Bahrain.
**Duties & 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 organization’s 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
**Qualification & Requirements**:
- 2-3 years’ experience preferably within the health care industry
- Medical / Nursing qualification
- 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
**Job Type**: Contract
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