Job Description

Core Responsibilities:

• Facilitate the dental authorization process by reviewing cases in accordance with clinical guidelines.
• Coordinate with healthcare providers to clarify treatment plans and ensure adherence to policies.
• Implement authorization decisions based on medical necessity, policy compliance, and cost-effectiveness.
• Monitor authorization requests for patterns of overutilization or non-compliance.
• Organize case documentation and maintain accurate records of authorization approvals and denials.
• Provide clinical insights and recommendations for complex dental cases requiring further evaluation.
• Draft reports on authorization trends, key metrics, and performance indicators.
• Liaise with internal and external stakeholders to ensure smooth coordination of dental services.
• Conduct periodic reviews of provider compliance with dental authorization guidelines.
• Participate in audits and investigations related to dental claims and pre-authorization processes.
• Receive and address inquiries from providers regarding authorization decisions.
• Contribute to continuous improvement initiatives to enhance service quality and efficiency.

Quality & Excellence Management:

• Assure compliance with Daman’s medical policies, procedures, and regulatory requirements.
• Monitor key performance indicators related to dental authorization and identify areas for improvement.
• Participate in quality audits to assess adherence to authorization standards.
• Implement corrective actions to resolve issues identified through quality assurance reviews.
• Ensure that all authorization decisions are well-documented and justified based on clinical evidence.

Key Requirements and Qualifications

• Minimum 3 years in any of the medical units of a health insurance company or third-party administrator (TPA), out of which minimum 1 year as Medical Authorisation Officer
• Certification in the medical coding systems is a plus
• Bachelor’s Degree in medicine

Skills and Competencies

• Good knowledge of health insurance concepts; knowledge of Health Insurance Fraud & Abuse is a plus
• Good command of written/spoken English; knowledge of Arabic language is an advantage
• Good analytical, execution, problem solving and decision-making skills
• Advanced level of customer service orientation and professionalism in all interactions