Responsible for implementing the necessary operations to communicate with employees and insurance companies to meet the health service requirements of employees.
Job Responsibilities:
Implement the quality standards of medical services provided to employees in the ELARABY with the aim of ensuring their application and achieving job satisfaction.
Prepare periodic reports on the medical service's compliance with contracting standards to support decision-making.
Utilization analysis and detection of the suspected abusers using analytical techniques through Power BI
Audit on the medications dispensed based on the member medical condition.
Review the chronic medications posted on the system and confirm it's medical necessity
Review employee consumption periodically to make recommendations.
Review the procedures necessary to avoid problems related to the use of the service.
Job Qualifications:
Bachelor's degree in pharmacy.
6-10 years of experience in medical insurance field.
Proficient with MS Office, Excel, Outlook and Power BI.
