Pre-Approval Officer

About the role

The Pre-Approval Officer ensures that all medical claim pre‑approvals are processed accurately, promptly and in compliance with insurance and regulatory requirements. Working within Al Futtaim Health’s claims department, the role bridges clinical documentation, coding standards and payer expectations to minimise revenue loss and improve approval rates.

Key responsibilities

• Review claim forms assigned on the dashboard and provide feedback.
• Update approvals received from insurance companies with 100% accuracy.
• Communicate with internal departments to obtain missing documents or additional information.
• Perform quantitative and qualitative analysis of patient records to verify completeness, coding compliance and documentation consistency.
• Ensure final diagnoses accurately reflect care rendered and meet third‑party reimbursement criteria.
• Receive daily patient medical records, identify deficiencies, and coordinate with physicians to resolve them.
• Submit pre‑approvals for IP, OP and pharmacy within KPI timelines.
• Monitor payer approval processes and apply customised actions to obtain first‑round approvals.
• Collaborate with coding teams and physicians to address IC rejections and complex cases.

Required profile

• Strong attention to detail and ability to work under tight deadlines.
• Excellent communication skills for interacting with physicians, coding teams and insurance representatives.
• Knowledge of healthcare coding guidelines and regulatory compliance.
• Proven ability to meet productivity and quality KPIs in a claims environment.

Required skills

• Medical coding
• Claims verification