Experienced Approval Doctor-Health Insurance Company

Company Description SEKEM Group, founded in 1977, is a leading producer, processor, and marketer of organic and biodynamic food products, textiles, and natural pharmaceuticals serving Egypt, the wider Arab region, and international markets. Organized as a holding company with a strong NGO arm, SEKEM integrates economic success with social engagement through cultural, educational, and developmental initiatives. The SEKEM Development Foundation runs schools, vocational training centers, and a medical clinic, advancing human development alongside sustainable agriculture. Through the Egyptian BioDynamic Association and related institutions, SEKEM promotes biodynamic farming across more than 800 farms in Egypt, Sudan, and Uganda, cultivating over 6,500 acres. Headquartered in Cairo and employing more than 2,000 people, SEKEM is a national market leader in herbal teas and a recognized pioneer in sustainable, socially responsible business.

Role Description The Experienced Approval Doctor will oversee and authorize medical services and claims for a health insurance company within SEKEM Group, ensuring that approvals align with clinical guidelines, insurance policies, and cost-effectiveness standards. This full-time role is based on-site in Cairo, Egypt, and involves reviewing medical reports, diagnostic findings, and treatment plans to determine medical necessity and coverage eligibility. The role includes close collaboration with healthcare providers, internal claims teams, and customer service to clarify medical decisions, resolve discrepancies, and support fair, timely claim processing. The Experienced Approval Doctor will contribute to developing and updating medical approval protocols, maintaining accurate documentation, and supporting audits and quality assurance activities. Day-to-day responsibilities also include staying current with medical best practices, relevant regulations, and insurance trends to improve approval processes and member care outcomes.

Qualifications

• Medical degree (M.B.B.Ch. or equivalent) with valid license to practice medicine in Egypt; specialization in internal medicine, family medicine, or a related clinical field is an advantage.
• Proven experience in health insurance, medical approvals, or utilization review, preferably with a focus on claims management and cost containment.
• Strong clinical assessment skills, including the ability to interpret medical records, diagnostic results, and treatment plans and to determine medical necessity.
• Solid knowledge of health insurance policies, reimbursement rules, and local healthcare regulations, with attention to compliance and ethical standards.
• Effective communication and negotiation skills for interacting with physicians, medical facilities, and internal stakeholders in a clear and respectful manner.
• High level of accuracy and attention to detail in documentation, case review, and decision recording, with strong organizational and time management abilities.
• Comfort with medical and insurance-related software systems, electronic records, and standard office applications; ability to learn new tools quickly.