Precertification Officer – Healthcare Claims

About the role

The Precertification Officer is responsible for obtaining prior authorizations for procedural orders, ensuring efficient completion of the authorization process with commercial payers. The role supports the team’s KPIs by meeting turnaround times and maintaining high productivity.

Key responsibilities

• Assess medical approvals and policy compliance, deciding on treatment plans and high‑cost claims.
• Input verbal and written claim approvals, adjudicate outpatient pre‑certifications on a FIFO basis.
• Maintain productivity targets: 85% of cases within 10 minutes and 98% within the first hour.
• Provide clear feedback to call‑centre teams and explain declined claims to clients.
• Coordinate workflow to meet deadlines and evaluate eligibility of claims.

Required profile

• Bachelor’s degree in Science.
• At least 2 years of medical practical experience, preferably with an insurance provider, broker or TPA.
• Fluency in Microsoft Office (Excel, Word, Outlook, PowerPoint) and strong internet research abilities.

Required skills

• Microsoft Excel
• Microsoft Word
• Microsoft Outlook
• Microsoft PowerPoint
• Cloud‑based tools
• Machine Learning
• Artificial Intelligence
• Data Analytics