Medical Insurance Tpa jobs

We are seeking an experienced, proactive, and detail-oriented Insurance Coordinator to join our Pre-Auth Department. The ideal candidate must have 1 to 2 years of hands-on experience in the UAE healthcare setting, with a strong background in fulfilling pre-authorization processes, navigating local insurance portals (eClaimLink, Riayati), and liaising with TPAs.

You will play a critical role in securing medical pre-approvals, minimizing rejections, ensuring CPT/ICD coding compliance, and transitioning cases into smooth billing workflows as the role expands.

Core Responsibilities (Pre-Auth Fulfillment)

• End-to-End Approval Fulfillment: Process, submit, and manage online pre-authorization requests through UAE insurance portals and TPAs (e.g., NextCare, NAS, MedNet, Neuron, Sukoon, Daman) prior to patient procedures and consultations.
• Clinical Documentation Review: Review doctor notes, diagnostic test results, lab reports, and treatment plans to verify medical necessity and align with CPT/ICD-10 coding guidelines before submission.
• Portal & Query Tracking: Continuously monitor pending authorization queues on payer portals, respond promptly to medical queries from insurance underwriters, and resolve approval delays.
• Clinical & Physician Coordination: Work directly with treating physicians to obtain clear clinical notes, justification letters, or additional diagnostic reports needed to satisfy TPA requirements.
• Patient Clearance & Co-Pay Calculation: Verify patient eligibility, coverage limits, deductibles, co-payments, and exclusions under specific policy tiers, informing front-desk and clinical staff accordingly.
• Rejection Management & Reconsiderations: Monitor authorization rejections, assess denial and down coding rationale, and prepare timely appeals or reconsiderations with comprehensive clinical evidence and supporting documentation.

Qualifications & Requirements

• UAE Experience: 1 to 2 years of direct experience as an Insurance Officer, Pre-Auth Coordinator, or Medical Billing Specialist within a medical center, hospital, or diagnostic center in the United Arab Emirates.
• Regulatory & Portal Knowledge: Hands-on experience with UAE insurance portals, TPA platforms, and e-claiming frameworks (e.g., eClaimLink, Riayati,).
• Coding Knowledge: Practical understanding of ICD-10-CM diagnosis coding, CPT procedural coding, and medical terminology.
• Language Skills: Excellent written and spoken English skills; fluency in Arabic is an added advantage.
• Computer Literacy: Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, and Outlook)

Job Type: Full-time

Experience:

• Diagnostic centre insurance: 3 years (Required)

Work Location: In person