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Job Description
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.
Job Requirements
- Doctor degree is mandatory
- Business Management Certificate or equivalent is a plus
- 8 years’ experience; preferably in the 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