Insurance Executive

Job Title: Insurance Executive
Location: Fujairah, UAE
Job Type: Full-time

Job Summary:
The primary purpose of this position is to manage the IP Approval claims process. You will assist in day-to-day approval functions for insured beneficiaries in accordance with the submission conditions outlined in the Standard Provider Contract signed with payers, ensuring alignment with hospital operations.

Key Responsibilities:

1. Coordination and Networking:
   - Collaborate with insurance companies regarding approvals for both outpatient and inpatient eligibility payments and other requirements.
2. Pre-Authorization Management:
   - Obtain pre-authorizations from insurance providers according to operational standards.
3. Contractual Compliance:
   - Ensure accurate application of contractual prices, discount schedules, benefit allocations, deductible collections, co-payments, and adherence to policy limits.
4. Claim Form Coordination:
   - Work closely with doctors, nursing staff, and ward teams to gather necessary claim forms.
5. Approval for Medical Procedures:
   - Secure approvals for medical procedures and handle pre-approvals for radiology, dental, obstetrics, and other specialties.
6. Query Management:
   - Address queries from doctors, insurance companies, and insured members related to claims processing, evaluation, and administration.
7. Customer Service Excellence:
   - Deliver outstanding customer service to insurance companies and insured members to achieve maximum satisfaction.
8. Additional Duties:
   - Perform other related tasks as assigned.

Educational Requirements:
- Bachelor’s Degree or Associate Degree in a related medical field.

Required Experience:
- Minimum of 3-5 years of experience in healthcare, preferably in the Northern Emirates.
- CPC or CCS certification is a plus.
- Relevant medical field experience and qualifications.
- Ability to manage the insurance department independently.
- Familiarity with the latest medical coding standards.