Medical Doctor – Insurance Approvals (3-5 yrs experience)

About the role

The Medical Approval Specialist reviews and approves pre‑approval requests from hospitals and clinics, ensuring compliance with policy terms and delivering high‑quality service to members and clients.

Key responsibilities

• Review and approve payment on pre‑approvals received from providers.
• Consult with the Provider Relation Department on pricing or CPT code discrepancies.
• Coordinate with the Clinical Team for complex admission cases.
• Respond to member/client calls and queries regarding pre‑approval status, eligibility, and plan benefits.
• Book every call/complaint and support the Customer Service Department.
• Assist in process improvements and recommend changes to the Team Leader.
• Process pre‑certification requests in the Claims Management System (CMS) applying policy terms.
• Follow the Operating Procedures Manual and company policies.
• Perform miscellaneous tasks assigned by the manager and work rotated shifts/weekends as required.

Required profile

• MBBS degree.
• 3‑5 years of experience in medical approvals or claims processing.
• Strong knowledge of CPT coding and insurance policy terms.
• Excellent communication skills for interacting with providers and members.

Required skills

• CPT coding