Pre-Authorization Officer

The Pre-Authorization Officer serves as G-Gulf’s principal representative to all key stakeholders. This role encompasses providing support, issuing necessary approvals, and ensuring compliance with the adopted guidelines and protocols for G-Gulf adherents.

Duties & Responsibilities

• Make the necessary administrative and medical clearance to provide medical decision for IN, OUT, pharmacy, and ER claims as per GML guidelines & protocols
• Coordinate with Medical Officers and the Medical Review Committee to provide correct decision
• Visit patients and check on their Identity & their Medical status
• Inform the patient about all details related to his coverage (In, Out, Excess, limitation, Rejection...)
• Fill Concurrent review
• Handle the chronic medicine files while coordinating with risk-carriers, Medical Services department, and following Chronic guidelines and protocols
• Check on false declarations and take necessary action
• Maintain the bills cycle within deadlines
• Identify cases for telemedicine, second opinion, and special treatment
• Monitor the length of stay, utilization, medical cases and their related costs
• Validate medical files
• Assist in conducting quality control
• Train new Delegates in the PSD department when needed
• Handle customers, risk carriers, and providers’ requests, complaints, and inquiries
• Coordinate with Providers to resolve all problems encountered by our adherents
• Coordinate with the Supervisor for all complicated cases
• Handle, coordinate, and follow up on office supplies, maintenance, and related needs
• Issue reports related to the works’ progress
• Manage the office, organize and set priorities for the workflow
• Preserve GlobeMed Lebanon’s brand image among its stakeholders

Qualifications

• Bachelor’s degree in Nursing, Pharmacy, or related medical field.
• 2–4 years’ experience in pre-authorization/utilization review within a TPA or insurer.
• Strong knowledge of medical terminology, ICD-10/CPT codes, and policy benefits.
• Ability to assess medical necessity and coverage eligibility.
• Familiar with pre-auth/claims systems (eClaimLink, DHPO, etc.).
• Detail-oriented, analytical, and able to meet turnaround times.