Precertification Officer - Pharmacist

Precertification officer provides quality service to clients, promptly and effectively assesses and process claims and approval according to operations set standards.

Key responsibilities/What you do:

• Assesses approval of medical approvals as well as policy use.
• Checks particular treatment plan is necessary for the patient.
• Inputs verbal and written claims approvals regularly.
• Decides approvals as per policy conditions.
• Assess high cost claims and provide decision on high cost and complicated cases.
• Provides clear feedback on queries from call Centre team.
• Provides clients an understanding of any declined medical claims.
• Coordinates work flow & meet deadlines.
• Evaluates claims with regards to eligibility.
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