Rehab Ayman Omar Mohamed
Claims Officer,MedNet Hub
Summary
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
7
7
years of professional experience
2
2
Languages
Work History
Claims Officer
MedNet Hub
09.2021 - Current
- Examine claims records and forms to determine whether the patient has medical insurance.
- Review provisions of certificate or policy to determine the patient's included medical coverage losses.
- Negotiate claim settlements and make recommendations for legal action when settlements are deemed non-negotiable.
- Complete logs, reports, forms and records to properly document medical claims.
- Reject or accept documentation, determine benefit due, and start the denial or payment process to resolve medical claims.
- Adhere to all company policies, procedures and guidelines in addition to insurance regulations at the federal and state level.
- Examine medical treatment records, police reports, physical property damage and medical bills to gauge overall extent of liability.
- Interview and communicate with claimants, police, witnesses, physicians and other necessary individuals to decide claim denial, settlement or review.
- Ensure all claims information remains confidential.
- Engage in continuing education and training opportunities when possible.tandard of professionalism in interactions with clients.
- Improved interdepartmental communication to expedite claims processing and foster a collaborative work environment.
- Prepared comprehensive reports for upper management detailing key findings from investigations into complex claim cases.
- Reviewed contracts thoroughly to ensure proper coverage for various types of insurance policies held by clients.
- Minimized fraudulent claims by conducting thorough investigations and collaborating with law enforcement agencies.
Hospital Pharmacist(Emergency) Department)
Ain Shams General Hospital
01.2022 - 01.2023
- Performed critical medication reconciliations upon patient admission and discharge to minimize adverse drug events associated with transitions of care.
- Verified safety and accuracy of physician orders.
- Dispensed and procured medicinal products and supplies used in hospital.
- Developed effective relationships with physicians, nurses, and other healthcare professionals to ensure optimal communication and collaboration in patient care.
- Provided accurate drug information to healthcare providers on the safe use of medications within the hospital setting.
Community Pharmacist(Shift Manager)
Yathrab Pharmacies Chains
09.2018 - 09.2021
- Collaborated with pharmacy team members to optimize operations and deliver outstanding patient care experiences.
- Improved patient medication adherence by providing comprehensive counseling and follow-up consultations.
- Provided exceptional customer service by addressing individual concerns and prioritizing patient needs.
- Assisted patients with over-the-counter medication recommendations and responded to questions concerning drug interactions.
- Participated in local health fairs to provide valuable information on various topics including medication safety and wellness strategies.
- Educated patients on over-the-counter product selection and proper usage, ensuring safe and effective self-care choices.
Education
Bachelor of Pharmaceutical Studies(Very Good )
MTI University
Cairo01-2018
Skills
Time management
Multitasking Abilities
Excellent communication
Investigation techniques
Decision-making
Adaptability and flexibility
Active listening
Teamwork and collaboration
Training
Traninee at Tivoli pharmacy (2016 and 2017)
Timeline
Hospital Pharmacist(Emergency) Department)
Ain Shams General Hospital
01.2022 - 01.2023
Claims Officer
MedNet Hub
09.2021 - Current
Community Pharmacist(Shift Manager)
Yathrab Pharmacies Chains
09.2018 - 09.2021
Bachelor of Pharmaceutical Studies(Very Good )
MTI University