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|Experince||5 Years||Salary||35,000 - 40,000|
|Job Type||Full Time||Shift||on-site|
|Category||Marketing||Career Level||Entry Level|
|Posted On||5/29/2018||Last Date||Jun 9,2018|
|Location(s)||Humana Building Louisville, Kentucky, U.S.|
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 statistical reports to facilitate management of medical operations and containment of claims’ cost for management decision-making.
• Handling member and provider queries promptly and provide accurate information relating to medical cases.
• Maintain call center key performance indicators and ensure high quality of service is provided to our members and providers.
Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky. As of 2014 Humana has had over 13 million customers in the U.S.,[not in citation given] reported a 2013 revenue of US$41.3 billion, and has had 51,600 employees. In 2013, the company ranked 73 on the Fortune 500 list, which made it the highest ranked (by revenues) company based in Kentucky. It has been the third largest health insurance in the nation.
The U.S. Dept. of Health and Human Services investigated Humana in 2009 for sending flyers to Medicare recipients that the AARP characterized as deceptive. The company's managed care model has also been criticized for ethical lapses and limitations.
The health insurer Aetna said on July 3, 2015, that it had agreed to acquire its smaller rival Humana for $37 billion in cash and stock but walked away from the deal after a court ruling that the merger would be anti-competitive.
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