JOB PURPOSE : Coordinate and perform the implementation of SAICO medical approval operation services
KEY RESPONSIBILITIES : Conduct ongoing clinical evaluation of treatment plans and return‑to‑work plans in accordance with established medical standards and protocols. Process and manage all medical approval transactions per shift, ensuring adherence to approved policies and coverage guidelines. Ensure compliance with approval Turnaround Time (TAT) as follows: Out‑Patient (VVIP, VIP, A Classes): 0–10 minutes Out‑Patient (B, C, D Classes): 0–15 minutes In‑Patient (All Classes): Less than 60 minutes Review and respond to approval requests as per policy coverage, requesting additional medical information when required to support appropriate decision‑making. Coordinate with medical providers to ensure appropriate care delivery and suggest cost‑effective treatment alternatives when medically appropriate. Maintain effective communication with healthcare providers not covered by field doctors to ensure continuity and quality of care. Obtain and review medical records and supporting documentation from providers during initial contact, with appropriate follow‑up through written correspondence. Liaise with medical providers and injured parties in cases involving medical treatment to coordinate appropriate and timely medical care. Improve the quality, clarity, and medical justification of approval responses while maintaining cost effectiveness of medical services. Identify and refer suspicious or high‑risk cases to the Fraud, Waste, and Abuse (FWA) team in line with internal guidelines. Ensure accurate documentation of all case activities, including contacts, decisions, and outcomes, within the system; submit billing or activity reports when applicable and required by standards. Participate in Learning & Development activities and complete a minimum of 25 training hours to maintain clinical, operational, and insurance knowledge.
QUALIFICATIONS & EXPERIENCE:Minimum Qualifications: Medicine Bachelor’s degree (MBBS). Licensed by the Saudi Commission for Health Specialties (SCFHS).
Minimum Related Experience: 1-3 years’ experience in related field.