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Precertification Officer

NEXtCARE
New Cairo, Cairo

Precertification Officer

New Cairo, CairoPosted 1 month ago
444Applicants for8 open positions
  • 0Viewed
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Job Details

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Job Description

  • Assesses approval of medical approvals as well as policy use
  • Checks particular treatment plan is necessary for the patient.
  • Inputs verbal and written claims approvals regularly.
  • Decides approvals as per policy conditions.
  • Assess high cost claims and provide decision on high cost and complicated cases.
  • Provides clear feedback on queries from call Centre team.
  • Provides clients an understanding of any declined medical claims.
  • Coordinates work flow & meet deadlines.
  • Evaluates claims with regards to eligibility.

Behavioral Requirements :

  • Strong verbal and written communication skills.
  • Show flexibility, excellent interpersonal skills.
  • Team Player.
  • Attention to detail and quality.
  • Ability to work well with all levels of internal management and staff, as well as outside clients and users.  
  • Ability to train other staff.
  • The ability to communicate sensitively and effectively with claims department and other departments having regard for the strict need for confidentiality.
  • Experience of working with senior managers and understanding the necessity to act in a pleasant and courteous manner and to be able to work effectively with others.
  • The ability to exercise initiatives and be able to work flexibly under pressure and to tight deadlines.

Job Requirements

  • Bachelor’s of Medicine\Pharmacy\Dentistry.
  • 2+ years Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus).
  • Legally permitted to work in the country of operations.
  • Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.

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