Job Purpose:

• 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.
• Very Good command in spoken and written English.

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