Muhamed Serag
Section Head
Cairo
Summary
- Dynamic professional with over 12 years of experience in healthcare insurance and claims management, leading teams to enhance operational excellence and drive efficiency. Expertise encompasses claims and fraud detection, healthcare insurance, and advanced data analytics, leveraging AI tools to inform strategic decision-making.
- Proven track record in managing complex projects and improving workflows, ensuring high-quality service delivery while mitigating risks.
- Strong leadership and communication skills facilitate effective collaboration with stakeholders and team members, fostering a culture of continuous improvement. Committed to utilizing extensive industry knowledge to achieve organizational goals and enhance patient care.
Overview
15
15
years of professional experience
Work History
Data and Medical Quality Management - Section Head
MedRight
11.2024 - Current
Medical Claims - Section Head
MedRight
01.2024 - 10.2024
Medical Approvals - Section Head
Medright
09.2023 - 12.2023
Assistant Manager - FWA
Mednet, Egypt.
07.2022 - 08.2023
- Handling policy performance / FWA reports and presentations.
- Communicate any detected fraud cases with both payers and clients through mails and meetings.
- Arrange investigation meetings with detected fraud providers to inform them with the company decision due to their fraudulent behavior.
- Building new control measures for the weakness areas to avoid further leakage.
- Training both Medical and Claims teams for the new scenarios of abusive trends.
- Working with the online system developer to find the best solutions of controls without affecting the service.
- Develop project concepts and maintain optimal workflow.
Medical Claims Operation Team Leader
Mednet, Egypt.
04.2020 - 07.2022
- Reconciliation / Re-submission arm handling (Provider).
- PIC relation for all audit queries.
- Monitoring Batch Unit workflow within the agreed SLA.
- Monitoring Dispatching workflow and fund extraction.
- Online Reimbursement.
- Resolving all claims pending queries.
- Estimated claim form booklets request.
- Provider care.
- Estimated reconciled amount for MRE reserves.
- FWA – detection, prevention unit.
Medical Claims Team Leader
Mednet, HUB.
02.2019 - 03.2020
- Receiving full volume of UAE NW Claims (OP Evaluation–OP Processing – IP international claims – Batch receiving unit)
- Leading team consists of 20 Colleagues who can absorb the full volume of claims with the desired quality.
- Meeting the announced average cost for different type of claims.
- Communicate all the pending queries with in-house team on daily, weekly, and monthly basis.
- Meeting the agreed TAT (15 Days) for all different type of claims.
Senior Reimbursement Officer
Mednet, HUB.
07.2016 - 01.2019
- UAE Reimbursement project group lead.
- UAE OP network claims group leader and supervision for both Adjudication and processing teams.
Medical Claims Officer
Mednet, Egypt.
07.2015 - 06.2016
Reimbursement Analyst
Al-Ahly Medical Company - AMC
05.2014 - 07.2015
Deputy Branch Manager
Misr Pharmacies – (Mashaal Branch)
01.2014 - 05.2014
Senior Pharmacist
EL-Ezaby Pharmacies – (Shoubra Branch)
06.2013 - 12.2013
Senior Pharmacist
AL-Tawafoq Pharmacies
05.2011 - 05.2013
Pharmacist
Ali's Image Pharmacies – Moustafa Tawakol Branch.
07.2010 - 04.2011
Education
Bachelor of Pharmacy - Pharmaceutical Sciences
Cairo University
Masakin Shiratun, Egypt 04.2001 -
Bachelor of Pharmacy - Pharmaceutical Sciences
Cairo University
04.2001 -
Skills
- Payer and Provider Reconciliation
- Claims & Fraud Detection – Ensuring accurate claims processing and identifying FWA risks
- Project Management – Improving workflows, automation, and system efficiency
- Business Analysis – Developing business requirements and optimizing processes
- Critical thinking and problem solving
- Leadership & Communication – Managing teams, negotiating skills, and engaging with stakeholders
- AI & Data Analytics – Using AI tools, Excel, and Power BI for data analysis and decision-making
- Microsoft Office – Proficient in Excel, PowerPoint, Word, and Outlook for reporting and presentations
- Problem-Solving – Strong analytical skills for resolving healthcare and insurance challenges
- Flexibility and Adaptability
Timeline
Data and Medical Quality Management - Section Head
MedRight
11.2024 - Current
Medical Claims - Section Head
MedRight
01.2024 - 10.2024
Medical Approvals - Section Head
Medright
09.2023 - 12.2023
Assistant Manager - FWA
Mednet, Egypt.
07.2022 - 08.2023
Medical Claims Operation Team Leader
Mednet, Egypt.
04.2020 - 07.2022
Medical Claims Team Leader
Mednet, HUB.
02.2019 - 03.2020
Senior Reimbursement Officer
Mednet, HUB.
07.2016 - 01.2019
Medical Claims Officer
Mednet, Egypt.
07.2015 - 06.2016
Reimbursement Analyst
Al-Ahly Medical Company - AMC
05.2014 - 07.2015
Deputy Branch Manager
Misr Pharmacies – (Mashaal Branch)
01.2014 - 05.2014
Senior Pharmacist
EL-Ezaby Pharmacies – (Shoubra Branch)
06.2013 - 12.2013
Senior Pharmacist
AL-Tawafoq Pharmacies
05.2011 - 05.2013
Pharmacist
Ali's Image Pharmacies – Moustafa Tawakol Branch.
07.2010 - 04.2011
Bachelor of Pharmacy - Pharmaceutical Sciences
Cairo University
04.2001 -
Bachelor of Pharmacy - Pharmaceutical Sciences
Cairo University
04.2001 -
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