Key responsibilities/What you do:

• Evaluate and approve medical requests in line with policy guidelines.
• Verify the necessity of treatment plans for patients.
• Regularly enter verbal and written claims approvals.
• Make approval decisions based on policy terms.
• Review and decide on high-cost and complex claims.
• Provide clear, detailed feedback to the Call Centre team’s inquiries.
• Explain reasons for declined medical claims to clients.
• Manage workflow efficiently to meet deadlines.
• Assess claims for eligibility criteria

Key requirements/What you bring:

• Bachelor’s degree in Medicine, Pharmacy, or Dentistry.
• Minimum of 2 years practical medical experience (experience with reputable insurance providers, brokers, or TPAs is advantageous).
• Legal authorization to work ...