Approval Officer

JobsCloseBy Editorial Insights

At NMC Healthcare in Abu Dhabi, this full‑time on‑site Approval Officer role involves reviewing pre‑authorization requests from multiple departments, ensuring medical necessity and regulatory alignment, applying accurate medical coding (ICD, CPT, DRG, HCPCS), and expediting insurer responses while handling denied cases with doctor justification. You’ll prepare reports, support month‑end processes, audit documentation, train front office and nursing staff, and assist with OSH compliance. The ideal candidate is MBBS with 2+ years in insurance claims management/adjudication, strong English, solid MS Office skills, and the ability to work under pressure, nights, and holidays. To apply, customize your résumé to showcase pre‑auth success, coding certifications, risk management examples, and collaboration with TPAs and auditors.

2.1 Apply medical knowledge and best insurance practice while reviewing and verifying the Pre Approval requests (OP/ IP) received from different departments to obtain authorizations as required by insurance companies dependent upon the plan coverage for all Insurance patients. Ensure that the details of the Pre Authorization Requests are in line with the regulators’ standards especially the claim adjudication Rules and Business Rules.
2.2 Handling the rejected pre authorization and get required justification from the treating doctor to resend it to Insurance Company and obtain the approval.
2.3 Prepares reports of daily activity as requested for management and assists management in month end reporting as requested.

• Evaluate pre-approval requests for medical necessity based on the clinical information provided.
• Accurately code service descriptions stated in prior authorization requests in accordance with accepted medical coding rules, medical guidelines, and the policy schedule of benefits.
• Respond promptly to Insurance/TPA queries and coordinate with concerned departments for timely resolution.
• Receive, evaluate, and escalate second-opinion cases and case management matters as required.
• Perform night shifts and public holiday duties as per the approved duty roster.
• Prepare daily activity reports as required by management and assist with monthly reports.
• Handle the auditing process by arranging required documents and coordinating with coders to support external auditors.
• Attend meetings and presentations as required.
• Conduct training for Front Office, Reception, and Nursing staff and keep them updated on insurance-related requirements and processes.
• Prepare cost estimates for procedures for cash-paying patients.
• Adjust and manage duties in the event of sudden or emergency unplanned leave of colleagues.
• Manage pending cases and ensure proper handover to colleagues in the next shift.
• Perform any other duties assigned by the HOD within the scope of the job role.
• Comply with all OSH and infection control policies, standards, and procedures.
• Follow documented OSH procedures, instructions, and assigned responsibilities.
• Maintain familiarity with emergency and evacuation procedures.
• Promptly report OSH hazards, incidents, near misses, and other safety-related issues.
• Assist with the preparation of risk assessments and incident reports.
• Comply with waste management policies and procedures.
• Attend applicable OSH and infection control training programs, mock drills, and awareness programs.
• Ensure appropriate use of personal protective equipment (PPE) and safety systems.

• 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.
• Flexible and able to work effectively under pressure.
• Excellent proficiency in Microsoft Office applications.