Medical Approval Officer

About the role

The Medical Approval Officer will coordinate and execute SAICO’s medical approval operations, ensuring timely and compliant processing of treatment and return‑to‑work plans. This role acts as a bridge between healthcare providers, injured parties, and internal teams to guarantee appropriate care while managing cost‑effectiveness.

Key responsibilities

• Conduct clinical evaluation of treatment and return‑to‑work plans according to established medical standards.
• Process all medical approval transactions per shift, adhering to policy and coverage guidelines.
• Meet turnaround time targets: 0‑10 min for VVIP/VIP Out‑Patient, 0‑15 min for B‑D Out‑Patient, and under 60 min for In‑Patient cases.
• Review and respond to approval requests, requesting additional information when needed.
• Coordinate with medical providers to suggest cost‑effective alternatives and ensure continuity of care.
• Obtain, review, and document medical records and supporting documentation.
• Identify and refer suspicious or high‑risk cases to the Fraud, Waste, and Abuse team.
• Maintain accurate case activity logs and submit required billing or activity reports.
• Participate in learning and development, completing at least 25 training hours.

Required profile

• Medical degree (MBBS) and license from the Saudi Commission for Health Specialties (SCFHS).
• 1‑3 years of experience in a related medical or insurance approval role.
• Strong knowledge of clinical evaluation and medical approval processes.

Required skills