Precertification Officer

About the role

The Precertification Officer is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with commercial payers, ensuring high efficiency and adherence to turnaround times. The role involves assessing medical approvals, evaluating high‑cost claims, and providing clear feedback to internal teams and clients.

Key responsibilities

• Assess medical approvals and policy compliance for each claim.
• Verify that treatment plans are necessary and appropriate for patients.
• Input verbal and written claim approvals and decide approvals according to policy conditions.
• Evaluate high‑cost and complex cases, providing timely decisions.
• Provide clear feedback to the call‑centre team and explain declined claims to clients.
• Coordinate workflow, meet deadlines, and maintain productivity targets (85% within 10 minutes, 98% within the first hour).
• Adjudicate outpatient pre‑certifications on a first‑in‑first‑out basis and ensure 100% schedule adherence.

Required profile

• Bachelor of Science degree.
• Minimum 2 years of medical‑related experience, preferably with an insurance provider, broker, or TPA.
• Fluency in Microsoft Office applications and strong internet research abilities.

Required skills

• Microsoft Excel
• Microsoft Word
• Microsoft Outlook
• Microsoft PowerPoint

What we offer

• Work in a world‑leading B2B2C insurance and assistance organization.
• Access to an AI‑driven environment with a focus on ethical data use and security.
• Inclusive workplace that promotes equal opportunities and professional growth.