Senior Officer – Authorization

MedNet Jordan is one of the leading managed care service organizations that caters to healthcare needs. We are currently seeking to hire a Senior Officer – Authorization (on Hybrid working modules basis) with the following tasks and responsibilities:

Your Job

 Medical Claims Evaluation:

·       Authorization for in-hospital cases in respect of medical necessity and appropriateness.

·       Evaluation & approval of outpatient claims need authorization in respect to the medical necessity and appropriateness and check them in the system to ensure high quality and correct services.

·       Chronic soap evaluation, issue, checking, sign & stamp.

 Business Correspondence

·       Manage queries from providers, Insurance Companies and insured members relating to claims authorization, evaluation and administration.

·       Provide medical guidance to the Claims Department staff and assistance in ICD coding and other relevant medical issues related to diseases, new procedures, and case management.

·       Responding to all international account’s requests and all inquiries from insurance companies.

 Client Servicing

·       Deliver excellent customer services to Insurance Companies and insured members with view of achieving maximum client satisfaction.

·       Client management / attending hospital visits to investigate on claims in order to minimize fraud and abuse when requested.

Your Profile 

Minimum Qualifications:

·       Bachelor Degree in Nursing Science, Pharmacy, Paramedical certificate 

Minimum Experience:

·       4 years' experience in his/her education field.

·       Minimum 2 years’ experience in claims management in the insurance industry or a TPA/MSO company. 

Job-Specific Knowledge & Skills: 

·       Computer literacy (MS Office, Excel, PowerPoint)

·       Knowledge related to medical terminology

·       Good Command in English language.

·       Industry knowledge related to local healthcare services system would be a must.