Approval Officer

About the role

The Approval Officer will apply medical knowledge and best insurance practices to review and verify pre‑approval requests for both outpatient and inpatient services. This role ensures that all requests comply with regulator standards, claim adjudication rules, and the specific plan coverage of insurance patients.

Key responsibilities

• Evaluate pre‑approval requests for medical necessity and accurately code service descriptions according to accepted medical coding rules and policy schedules.
• Handle rejected pre‑authorizations, obtain justification from treating doctors, and resubmit to insurance companies.
• Respond to Insurance/TPA queries promptly and liaise with relevant departments.
• Receive, evaluate, and escalate second‑opinion cases and manage case workflows.
• Prepare daily activity reports and assist with monthly management reporting.
• Attend meetings and presentations as required.
• Adjust duties during colleagues' sudden or emergency leaves and hand over pending cases to the next shift.
• Perform any other duties assigned by the Head of Department.

Required profile

• Strong medical knowledge and understanding of insurance policies and claim adjudication processes.
• Ability to interpret and apply medical coding rules and schedule of benefits.
• Excellent attention to detail and ability to work under tight deadlines.
• Effective communication skills for interacting with doctors, insurers, and internal teams.

Required skills

• Medical coding proficiency.
• Insurance claim processing knowledge.