My role is to support QLM to ensure medical spending (In-Patient & Out-Patient services) is controlled by ensuring that pre-authorization decisions are within defined regulations, accepted guidelines and high-quality medical standards, safeguarding the member's health & safety and aligned to QLM Values. Also includes: • Medial cost & Service Management: Adjudicate the cases (In-Patient & Out-Patient) based on common medical practice and in line with QLM protocols and policy. • Ensure the decisions are according to the best medical standards and agreement terms & conditions to prevent abuse, fraud, and overtreatment. • High quality medical decision & patient safety: Ensure working with high quality of decision making with Zero QDI (Quality Demerit Index) A or B. • Ensure the medical decisions are consistent and are implemented based on clinical and practice guidelines signed by the organization. • Ensure high customer satisfaction in line with QLM values and business strategy. • Efficiency management: Ensure you achieving the daily targets in terms of productivity & speed of response. • Ensure proper interpretation and usage of clinical skills. • Develop standards and processes to promote provider quality, appropriate services, and patient safety. • Compliance with policy and Regulation: Report all high value claims as per agreed process. • Analyse, evaluate and finalise the applications from Healthcare Providers • Build and maintain strong working relationships with stakeholders both internally and externally. • Highlight and report fraud, abuse, and anti-selection. • Ensure accurate record-keeping and support audit team. • Align with leading industry practices and techniques to ensure continuous improvement. • Prepare and deliver training to new doctors. • Handle phone calls during and outside of working hours, as necessary to facilitate and expedite outcomes. • Notify the department manager where non-compliance is found and investigate accordingly. • Attend meetings, conferences, and workshops, and give presentations to address any issue related if needed. • Perform other duties as requested to meet the ongoing organizational needs.

• Customer contact center experience in a health care and hospitality-related industry. • Make & review medical orders for medical equipment & cosmetics … etc. • Medical workshop & training for doctors on how to use medical devices. • Maintain a high standard of patient focus while generalizing, evaluations, or decisions based on sensory or judgmental criteria. • Conduct pharmacies, clinics and hospitals visit to support doctors for any medical inquiries regarding medical equipment.

• Inspecting and updating patients' charts. • Diagnosing common ailments such as colds, flu, and diabetes. • Administering medication topically, orally, and via intravenous or intramuscular injections. • Prescribing apt medications and lifestyle alterations. • Collecting fluid and tissue samples and sending these to laboratories for further testing. • Referring patients to specialists for further testing and treatment, if needed. • Creating and issuing invoices to private clients. • Submitting claims on behalf of patients who have health insurance. • Anticipating and responding to patients' wellness-related questions and concerns.