Description

Job Description

Precertification Officer – Pharmacist 

Precertification officer provides quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards.

Key Responsibilities/What You Do

• Assesses approval of medical approvals as well as policy use.
• Checks particular treatment plan is necessary for the patient.
• Inputs verbal and written claims approvals regularly.
• Decides approvals as per policy conditions.
• Assess high cost claims and provide decision on high cost and complicated cases.
• Provides clear feedback on queries from call Centre team.
• Provides clients an understanding of any declined medical claims.
• Coordinates work flow & meet deadlines.
• Evaluates claims with regards to eligibility.
• AI READINESS Work effectively in an environment shaped by artificial intelligence (AI), machine learning, data, analytics and cloud-based tools, using insights responsibly with our standards of data governance, security and ethical use.
  

Key Requirements/What You Bring

• Bachelor’s of Pharmacy.
• 2+ years Medical Practical Experience (reputable insurance provider, broker or a TPA experience a plus).
• Legally permitted to work in the country of operations.
• Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.