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Job Description
The Utilization Reviewer is responsible to Monitor the accounts utilizations. In addition to that, He has to analyze the utilization reports for cost containment recommendations and development of wellness tips and healthcare programs accordingly.
- Monitoring the account's consumption on a monthly basis.
- Monitor pool consumption.
- Deep analysis for the services per account as per the contract terms,
- Review the top claimants' consumption and report them.
- Monitor the abuse and fraud cases.
- Prepare an action plan for cost containment and renewals for the accounts.
- Link the consumption reports with the healthcare solutions.
- Prepare general and customized wellness tips.
Job Requirements
- Bachelor’s degree Medical Background (pharmacist is a must).
- 1-2 Years experience in Same Field.
- Data Analysis skills is a must
- Excellent Excel user is a must
- Very good written and spoken English.
- Presentation skills.
- Insurance background.
- Free from the governmental assignment.
- Proactive mindset.
- Communication and Negotiation skills.
- Follow up skills.
- Team player.
- Organized.
- Self-Motivated.
- Goal Oriented.
