Pre-Approval Doctor

Minimum Requirements:

• Applicants must be willing to work and relocate to Clark, Pampanga.
• Applicants must be a Filipino citizen or have a relevant residence status
• Medical Degree from a recognized university
• Current License to practice in the Philippines
• Experience working in a medical insurance field is preferred
• 2 years post qualification experience, preferably in Emergency Room, General Practice or Family Medicine
• Computer literate, Proficiency in the MS Office Suite of Software. (Excel/Word/Power Point)
• Proficiency in written and spoken English.

Key Responsibilities and Accountabilities:

• Action pre-approval transactions from contracted medical providers in line with agreed operating procedures and service level agreements
• Use medical training, knowledge and departmental guidelines to ensure accurate assessment of pre-approvals
• Ensure consistent application and review of treatment plans to ensure cover in line with contracted pricing
• Complete system and written administration in line with audit requirements and ensure approvals are documented in correct detail to support smooth claims administration.
• Complete activities in line with service agreements while demonstrating ability to prioritise according to medical urgency
• Ensure correct reference to policy of all communication whether verbal or in writing
• Respond to call centre phone queries/ online chat function related to coverage queries and claims in line with published protocols.
• Other tasks may be assigned