1 Medical Management jobs in Saudi Arabia
Medical Approval Specialist – Medical Insurance Management
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Job Description
Job Brief:
Are you a medically qualified professional experienced in handling medical approvals and insurance coordination? Do you have a strong understanding of clinical evaluation and policy compliance?
If so, you are the one we are looking for
This is an excellent opportunity to join a reputed medical insurance management team, where you will evaluate treatment requests, ensure compliance with medical guidelines, and maintain accuracy in medical authorization processes while working closely with healthcare providers.
Key Responsibilities:
- Evaluate prior authorization requests for medical necessity based on provided medical reports and documentation.
- Code medical services accurately and classify cases (inpatient, outpatient, emergency, etc.) as per standard clinical practices.
- Verify that all requested services comply with best medical practices and insurance policy terms.
- Identify, document, and report misuse or potential fraud cases, ensuring necessary preventive actions are implemented.
- Monitor utilization patterns, detect early warning signs, and recommend cost-control measures.
- Respond promptly to inquiries from hospitals, clinics, and pharmacies to ensure smooth case coordination.
- Handle second opinion and case management requests and escalate complex cases to senior medical officers.
- Participate in night shifts and holiday rosters as assigned.
- Prepare daily and monthly activity reports as required by management.
- Validate the accuracy of services and pricing, identifying areas for cost optimization.
- Communicate with clients and providers in a professional and timely manner in accordance with company guidelines.
- Perform any other duties assigned by the direct supervisor related to the role.
Required Qualification / Experience / Skills:
- Bachelor's or Master's Degree in General Medicine & Surgery .
- Min 1 year of Saudi experience in medical approvals, insurance claims, or healthcare administration
- Familiarity with medical coding systems (ICD, CPT, etc.)
- Strong understanding of clinical practices and medical policy interpretation
- Proficiency in Microsoft Office and healthcare management systems
- Excellent communication and coordination abilities
- Strong analytical and decision-making skills
- Ability to handle multiple cases efficiently under pressure
Job Location: Saudi Arabia
Type of Employment: Permanent / Full-time
Salary Range: 7,000 – 12,000 SAR based on experience
What you can expect from the employer:
Competitive salary package based on experience
Dynamic and growth-oriented work environment
Training and career advancement opportunities
All other benefits as per Saudi Employment Law
Job Types: Full-time, Permanent
Pay: ﷼7, ﷼12,000.00 per month
Application Question(s):
- Do you hold a Bachelor's or Master's degree in General Medicine & Surgery?
- How many years of experience do you have in medical approvals or insurance management?
- Are you familiar with medical coding systems (ICD, CPT, etc.)?
- Are you willing to work rotational night shifts and on official holidays?
- Do you have prior experience in coordinating with hospitals, clinics, or insurance providers?
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