Analyst - Pre Authorization
HyderabadFull Time
CLAIMS
HEALTH CARE
PRE AUTHORISATION
Job description
Review
and validate pre-authorization requests for medical services and procedures.
Ensure completeness of documentation submitted
by policyholders and healthcare providers.
Verify eligibility and coverage based on policy
terms and conditions.
Coordinate with internal claims and
underwriting teams for complex cases.
Input and update pre-authorization decisions in
the claims management system.
Communicate authorization outcomes to providers
and insured members.
Ensure compliance with Hong Kong’s Insurance
Authority (IA) regulations and internal SOPs.
Identify and escalate potential fraud or abuse
cases to the compliance team.
Maintain turnaround time (TAT) and service
level agreements (SLAs).
Support audits and quality checks by providing
accurate documentation.
Participate in training sessions to stay
updated on regulatory changes.
Handle sensitive medical information with
strict confidentiality.
Service and resolve inquiries from customers,
members, beneficiaries, and others regarding Health Care products and benefits
across multiple product lines
Ability to communicate effectively across
multiple channels, including phone, e-mail, chat, and text
Ability to succinctly collect information from
a customer to set up a new claim
Ability to gather information from multiple
source systems to understand and articulate the claim – and what information
may be needed, next steps in processing, etc.
Skills Required
Analyst - Pre Authorization
ITES/BPO/KPO
ITES/BPO/Customer Service
Full Time, Permanent
Key Skills
- CLAIMS
- HEALTH CARE
- PRE AUTHORISATION
Other Information
GO/JC/748/2025
Gayathri B
