Executive, Preauthorization

About the role

The Executive, Preauthorization will lead medical audit and pre‑authorization activities, ensuring compliance, fraud control and high‑quality customer service within a 24/7 operational environment. You will act as the primary liaison between providers, clients and internal teams to manage case flow, cost control and regulatory adherence.

Key responsibilities

• Coordinate with providers for case management, cost control and timely adjudication.
• Handle customer, broker and provider queries, ensuring first‑time‑right resolutions and SLA compliance.
• Escalate unresolved issues according to policy and turnaround requirements.
• Support daily operations of the PAR unit, monitoring KPIs and internal/external SLAs.
• Implement medical pre‑approval processes and regulatory guidelines.
• Conduct onsite audits of suspected fraudulent practices and report findings.
• Review and audit medical approvals, closing pending cases.
• Maintain management information systems, quality controls and SOPs.

Required profile

• Medical degree or equivalent clinical qualification with extensive health‑insurance experience.
• Proven background in medical auditing, pre‑authorization, claims adjudication and fraud‑waste‑abuse control.
• Strong understanding of healthcare systems, insurance policies and regulatory requirements.
• Excellent written and verbal English; Arabic is a plus.
• Ability to manage multiple priorities in a 24/7 environment while meeting SLAs and KPIs.

Required skills

• MS Office Suite
• Healthcare claims management systems
• MIS reporting tools
• Medical coding standards (ICD, CPT)
• Process mapping and workflow documentation
• Lean and Six Sigma methodologies