The role operates within the Medical Operations Division and Authorisation Department, ensuring accurate, timely, and compliant processing of dental prior-authorisation requests.
The role supports claims adjudication, patient care navigation, and medical case management while contributing to objective of balancing high-quality member care with cost efficiency and profitability.
Key responsibilities include evaluating and processing dental prior-authorisation requests in line with defined daily targets, quality standards, and KPIs, while ensuring strict compliance with contractual prices, discounts, Schedule of Benefits, policy limits, and prior submission protocols.
To utilises core systems such as Documentum and contributes to the development and implementation of dental authorisation guidelines.
The role supports training initiatives for team members, escalates complex cases, provider trends, and operational issues to the supervisor, and reports suspected fraud or abuse.
A strong focus on customer service, medical ethics, documentation quality, and continuous improvement is essential to safeguard organisational integrity and service excellence.
Qualifications
Bachelor's degree in Dental Surgery or Doctor of Dental Surgery.
Experience in dental prior-authorisation or claims processing is preferred.
Job Types: Full-time, Permanent
Pay: AED5,000.00 - AED7,000.00 per month
Work Location: In person
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