Highly skilled and detail-oriented doctor with 6 years of experience in medical insurance field, securing a responsible career opportunity to fully utilize my trainings and skills making a significant contribution to the success of the company.
Liaise with medical and non-medical staff at providers to ensure quality healthcare service for our members. Maintain and update a daily database and tracker of all issues raised and members touched. Conduct follow up on open cases to ensure optimal members recovery and issue resolution.
Ensure medical spend (In-Patient & Out-Patient services) is controlled by ensuring that decisions are within defined SAMA & CCHI regulations, accepted guidelines and high quality medical standards, safeguarding the member's health &safety.
Dealing with various internal medicine cases regarding inpatient ward management, daily outpatient follow up and emergency visits.
Dealing with Gastroenterology and Hepatology patients cases as daily frequent outpatient visits, ward admission, order referrals and performing Endoscopies.
Leadership
Decision making
Data analysis
Adaptability
Problem solving
Communication Skills
• Award in General Insurance W01 (CII).
• Insurance Foundations Professional Exam - IFCE.
• Six Sigma Lean Black Belt in Healthcare.
• Health Care Anti-Fraud Associate (HCAFA).
• Healthcare Customer Service Associate (HCSA).
• Managed Healthcare Professional (MHP).
• Professional, Academy for Healthcare Management.
• Project Management Essentials.