Doha, Qatar - We are a leading medical insurance company located in Qatar, looking for a high-caliber medical officer who can perform the following duties and responsibilities: Approve inpatient and outpatient claims in line with policy terms and eligibility criteria, and ensure approvals are issued within set turnaround time. Prospective and concurrent medical review of hospitalized and non-hospitalized patients determining the medical necessity and appropriateness of diagnostics and medical treatments. Coordinate with providers to make procedures more cost effective. Review medical trends, identify fraudulent cases and bring them to the notice of Medical Manager to minimize abuse of medical insurance. Support company's operations in the implementation of quality assurance programs in order to maintain standards of quality and minimize fraudulent cases. Investigate, discuss and audit members' medical records within delegated authority. Develop and maintain daily, weekly and monthly statist...
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