Job Summary:The Medical Approval Doctor is responsible for reviewing and evaluating medical treatment requests, ensuring compliance with medical guidelines and insurance policy terms. The role involves making clinical decisions related to pre-authorizations, inpatient and outpatient approvals, and providing medical expertise in claims processing.Key Responsibilities:Evaluate and approve or reject pre-authorization requests based on medical necessity and policy coverage.Review inpatient and outpatient treatment requests in coordination with hospitals and healthcare providers.Communicate with physicians, hospitals, and insured members to clarify clinical cases and ensure appropriate care.Ensure decisions are compliant with company policies, local health regulations, and international medical guidelines.Provide medical support to the claims department for adjudication of complex medical claims.Keep up to date with new medical treatments, protocols, and policy changes.Contribute to the development and updating of internal medical protocols and guidelines.Maintain detailed documentation and records of medical decisions and approvals.