Approval Doctor
Tuba -
6th of October, Giza
Job Details
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Job Description
- Review and assess prior authorization requests for medical procedures, surgeries, diagnostics, lab tests, and medications.
- Ensure requests comply with insurance policy terms and the Council of Health Insurance (CHI) regulations.
- Communicate with healthcare providers to clarify or complete medical information when needed.
- Make sound and fair clinical decisions while balancing cost control and member care.
- Utilize internal medical authorization systems (e.g., TCS or equivalent).
- Identify and report suspected misuse or overutilization of health insurance coverage.
Job Requirements
- Bachelor’s Degree in Medicine & Surgery (MBBS or equivalent).
- Minimum of 3 years’ experience in medical approvals in Saudi Arabia.
- Strong knowledge of CHI (Council of Health Insurance) guidelines and benefit structures.
- Proficiency in ICD and CPT coding.
- Excellent clinical judgment and decision-making skills.
- Comfortable using medical systems and digital platforms.
