ASSOCIATE

Oman Insurance Company - Deira, Dubai - Job Title ASSOCIATE Location Deira , AE Organization Name Medical Par Team Department Description Brief Description Detailed Description The job holder will be responsible for Outpatient ComplexPreauthorization request administration and expensive items of Pharmacy BenefitManagement, expensive OP procedures and investigations, control of fraud /abuse and assurance of customer service escalations. Receive intimation fromProvider online or thru e-mail along with relevant medical reports forvalidation and approval as per policy Job Requirements · Coordinate with providers to proceed for eligible and indicated services only as per policy, and validate costly services like MRI, CT scan, PT and other OP repeated services. · Once the request is received on e-portal, call / or email, all the details are reviewed and validated in Shamil member data, HCS and ePAR approvals and claims history, confirm eligibility, medical necissity, cover match and available limits in related TOB again...

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