Approval Officer

NMC Healthcare
Abu Dhabi
Full timeFunction: Communications, PR & CommunityExperience: 2+ yearsEducation: bachelorsSkills: ["Attention to detail","Communication","Ability to work under pressure","Training","Documentation"]

Review and verify pre-approval requests for medical necessity, ensuring service descriptions are accurately coded and aligned with medical guidelines and the policy schedule of benefits. Handle insurance/TPA queries, evaluate and escalate second-opinion and case management matters, and manage pending cases with proper shift handovers. Prepare daily and monthly activity reports, support audits, train front office and nursing staff on insurance processes, and assist with risk and infection-control compliance.

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FursaFursa
NMC Healthcare
NMC Healthcare
2 days ago

Approval Officer

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Source: Company careers pageValidated by: Fursa AI
Last checked: 16 hours agoStatus: Live

Job Summary

Review and verify pre-approval requests for medical necessity, ensuring service descriptions are accurately coded and aligned with medical guidelines and the policy schedule of benefits. Handle insurance/TPA queries, evaluate and escalate second-opinion and case management matters, and manage pending cases with proper shift handovers. Prepare daily and monthly activity reports, support audits, train front office and nursing staff on insurance processes, and assist with risk and infection-control compliance.
Location: Abu Dhabi
Employment Type: Full time
Job Function: Communications, PR & Community
Seniority: Mid level

Key Responsibilities

  • •Evaluate pre-approval requests (OP/IP) for medical necessity and obtain required authorizations based on plan coverage.
  • •Accurately code service descriptions in prior authorization requests according to medical coding rules and benefits policy.
  • •Respond to Insurance/TPA queries and coordinate with departments to resolve issues promptly.
  • •Receive, evaluate, and escalate second-opinion cases and case management matters as required.
  • •Prepare daily activity reports, support audits with required documents, and assist with monthly reporting and training for front office and nursing staff.

Key Requirements

  • •Bachelor’s degree in Medicine (MBBS) from a recognized university.
  • •Minimum 2 years of experience in Insurance Claims Management/Adjudication.
  • •Proven experience in Medical Coding, including ICD, CPT, DRG, and HCPCS.
  • •Excellent command of spoken and written English.
  • •Excellent proficiency in Microsoft Office applications.
Experience:2+ yearsInsuranceHealthcareMedical codingMedical adjudication
Education:Bachelor's
Skills:Attention to detailCommunicationAbility to work under pressureTrainingDocumentation
Languages:English
Tech Stack:Microsoft OfficeICDCPTDRGHCPCS

Company Brief

NMC Healthcare
Operates a large network of hospitals, medical centers, and specialty clinics across the UAE and the wider Middle East. Provides general and specialized healthcare services, diagnostics, and outpatient care for individuals and families.
Industry: Hospitals & Clinics
Company Size: Enterprise (1,001+ employees)
Growth: Established Company
Headquarters: Abu Dhabi, United Arab Emirates
Founded: 1975
WebsiteLinkedIn