Job Purpose:
The Medical Approval Doctor will be responsible for reviewing and approving medical claims and treatments within the insurance policy process. This role involves assessing medical documentation, evaluating the necessity and appropriateness of proposed treatments, and ensuring compliance with company policies and regulatory requirements. The Medical Approval Doctor will collaborate with medical providers and clients to facilitate efficient and accurate claim approvals while maintaining high standards of patient care.
Key Responsibilities:
- Review and assess medical claims, including treatments and procedures, to determine appropriateness and adherence to policy guidelines.
- Collaborate with the underwriting team to evaluate the medical necessity of treatments and ensure they align with insurance coverage.
- Provide medical expertise and consultation to the underwriting and claims teams on complex medical cases and treatments.
- Communicate effectively with medical providers and clients regarding treatment approvals and insurance coverage.
- Analyze medical documentation, including reports, lab results, and clinical notes, to support decision-making processes.
- Ensure compliance with local regulatory requirements and company policies related to medical claims and approvals.
- Participate in quality assurance and improvement initiatives to enhance the efficiency of the claims process.
- Stay current with medical guidelines, advancements, and industry best practices relevant to insurance.
- Prepare and maintain accurate documentation of medical approval decisions and related communications.
Qualifications and Skills:
- Medical degree (MD) from a recognized institution.
- Valid medical license to practice in Saudi Arabia.
- Minimum of 3-4 years of experience in a hospital setting and 2 years in the insurance sector.
- Strong understanding of medical terminology, treatments, and regulations in the Saudi insurance market.
- Excellent analytical skills and attention to detail for evaluating medical claims and documentation.
- Effective communication and interpersonal skills for collaborating with medical professionals and clients.
- Ability to work in a fast-paced environment and manage multiple cases simultaneously.
- Proficiency in Microsoft Office.
