Precertification Officer

About the role

The Precertification Officer ensures that medical treatments requested by external parties are eligible, necessary, appropriate and cost‑effective. The role involves reviewing requests, issuing authorisations, and providing clear guidance to clients and healthcare providers.

Key responsibilities

• Receive and assess treatment requests from external parties, verify eligibility and issue authorisations.
• Complete authorisation data in the TATSH system according to policy wording and medical reports.
• Collaborate with the Precertification Doctor for complex or high‑cost cases requiring medical approval and signature.
• Communicate authorisation details, provide support and procedural advice to clients and providers.
• Liaise with the Team Leader/Deputy Precertification Manager to coordinate second opinions or field medical officer interventions for suspicious or difficult cases.
• Report complaints and process issues to the supervisor in writing.
• Maintain confidentiality of member data and ensure compliance with internal claims procedures.
• Assist patients courteously at the field office, verify discharge bills and forward information to the regional office.
• Participate in regular meetings and training sessions as directed.

Required profile

• Bachelor’s degree in Nursing.
• Minimum 1 year experience in the health‑care sector (TPA, insurance, hospital or medical centre).
• Physically fit to perform field duties.

Required skills

• Strong knowledge of medical eligibility criteria and insurance policies.
• Ability to use the TATSH authorisation system.
• Excellent communication and client‑service skills.
• Attention to detail and ability to handle confidential information.

What we offer

• Opportunity to work within a dynamic health‑care team.
• Professional development through regular training.
• Positive work environment focused on quality service.