Approval Officer - Insurance Pre-Authorization

About the role

Royal Khalifa City Hospital Abu Dhabi is looking for an Approval Officer who applies medical knowledge and insurance best practice to review and verify pre-authorization requests (OP/IP) from hospital departments. The officer obtains authorizations from insurance companies according to plan coverage, checks that request details match regulatory standards such as claim adjudication and business rules, and handles rejected requests until approved.

Key responsibilities

• Evaluate pre-approval requests for medical necessity and code service descriptions according to accepted medical coding rules, medical guidelines and the policy schedule of benefits.
• Handle rejected pre-authorizations, obtain justification from the treating doctor and resend them to the insurer.
• Respond to insurance/TPA queries and liaise with departments promptly; receive, evaluate and escalate second-opinion cases and case management requests.
• Prepare daily activity reports and assist management with month-end reporting.
• Perform night shifts and public holiday duties as per the duty roster.
• Handle the auditing process, arrange documents and coordinate with coders to support external auditors.
• Train front office staff, receptionists and nurses on insurance information, prepare cost estimates for cash-paying patients, and hand over pending cases between shifts.
• Comply with OSH and infection control policies, attend training and drills, and report hazards and incidents.

Required profile

• Bachelor's degree in Medicine (MBBS) from a recognized university.
• Minimum 2 years of experience in insurance claims management/adjudication.
• Experience in medical coding, including ICD, CPT, DRG and HCPCS.
• Excellent command of oral and written English.
• Flexible and able to work effectively under pressure.