Job description

The precertification officer is responsible for handling received requests from external parties, checking eligibility, and issuing authorization of medical treatments and ensuring that medical treatment given by providers is necessary, appropriate and cost effective.

The precertification officer provides high quality service; assists and informs clients/medical providers about the authorization response.

What you do

• Receive the requests from external parties, check claims eligibility and issue authorization of medical treatments, follow up on the case and ensure that medical treatment given by providers is necessary, appropriate and cost effective.
• Handle details of the authorization by completing the data on TATSH in accordance with the policy wordings and the information as relayed by the relevant medical report and/or the other relevant details and gathered by the precertification officer.
• Liaise closely with the precertification doctor in the pre-authorization of treatments and appropriate medical care for all in-patient claims and any other type of claim costly, suspicious or complicated whereby claim doctor medical approval & signature is required.
• Discuss the authorization’s details with clients and provide sympathetic support and both medical and procedural advice as appropriate.
• Liaise closely with the team leader/deputy precertification manager in the pre-authorization of treatments and appropriate medical care as per policy terms and conditions; suggesting the intervention of field medical officers/second medical opinions for suspicious, difficult and major cases.
• Report in writing to the supervisor regarding complaints received by the precertification department and relating to a specific communication and/or authorization process.
• Provide a high quality service, assist and inform clients/medical providers about the authorization response and make sure that clients’ requests are handled with no delay and with efficiency.
• Follow and apply the internal claims procedures for all types of claims.
• Responsible and accountable for the confidential, proper administration of insured member data as well as system, policy and medical information.
• Any other duties as requested by the direct manager.

Field

• Welcome and assist patients politely and professionally; display a positive attitude towards customers.
• Maintain a good professional relation with providers and staff to show a positive image of the company.
• Ensure daily medical follow-up, communicate all information to the assigned colleague at the regional office/precertification center.
• Check bill upon patient’s discharge and share the bill amount with the assigned colleague.
• Receive bills from providers when applicable as per internal procedure.
• Attend regular meeting/training sessions as directed by direct manager.
• AI readiness: work effectively in an environment shaped by artificial intelligence (AI), machine learning, data, analytics and cloud-based tools, using insights responsibly with our standards of data governance, security and ethical use.

What you bring

• Education: bachelors of nursing required.
• Experience: minimum 1 year experience within the health care industry (TPAs, insurance companies, hospitals, medical centers).
• Physically fit to carry out duties.
• Legally permitted to work in the country of operations.
• Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills.

How we hire

Agency statement: the company does not accept unsolicited CVs or approaches from agencies. We only work with partners on our approved supplier list, under contract. Any unsolicited submission will not be considered.

Key benefits / What we offer

We are a world leader in B2B2C insurance and assistance, offering global solutions that span international health and life, travel insurance, automotive and assistance. Customer driven, our innovative experts are redefining insurance services by delivering future-ready, high-tech high-touch products and solutions that go beyond traditional insurance. Our products are embedded seamlessly into our partners’ businesses or sold directly to customers, and are available through four commercial brands.

Artificial intelligence (AI) is transforming service delivery and innovation. By leveraging business intelligence and data analytics, we enhance strategic decision-making and customer experiences. Our commitment to ethical AI ensures responsible deployment, maintaining data integrity and trust. Conversational AI improves communication, while emerging technologies and generative AI drive industry leadership and new opportunities. With robust information security management, we protect sensitive information, ensuring compliance and security. Embrace the future of AI with us, where possibilities become realities.

About us

We are one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams and challenges, is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow and to shape a better future for our customers and the world around us.

We stand for unity: we believe that a united world is a more prosperous world, and we are dedicated to consistently advocating for equal opportunities for all. The foundation for this is our inclusive workplace, where people and performance both matter, and nurtures a culture grounded in integrity, fairness, inclusion and trust.

We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristics protected under applicable local laws and regulations.

Great to have you on board. Let's care for tomorrow.

Note

Having different strengths, experiences, perspectives and approaches is an integral part of our company culture. One means to achieve this is a regular rotation of employees across functions, entities and geographies. Therefore, the company expects from its employees a general openness and a high motivation to regularly change positions and collect experiences across the group.