Investigator
SARAH CAESSAR
Health Claims Customer Relations Team Leader
Cairo
Summary
Dedicated, self-driven, investigator, focused on result and people oriented.
- Experienced Health insurance , Domestic/Global , bringing around 10 years of quality performance in customer support supervisory roles with high accuracy while auditing high value medical cases .Ensure compliance with regulatory requirements and industry standards related to medical assistance services.Skilled in mentoring team members to deliver exceptional service and building team morale through effective communication and positive performance feedback. Accustomed to defusing customer dissatisfaction and managing competing priorities with superior results.
Overview
10
10
years of professional experience
2014
2014
years of post-secondary education
3
3
Languages
Work History
Health claims Customer relations Team Leader - Reimbursement Unit
Axa Egypt
08.2018 - Current
- Responsible on reimbursement communication with all channels ,ex. Retail , Direct accounts and Brokerage firms.
- Leading Health claims internal/external communication (via calls, ticketing systems, meetings, etc.)
- Leading Health claims communication, evaluating the situation, apply business criteria and detailed knowledge about Reimbursement Insurance/Axa policy terms and conditions
- Face to face communication, managing weekly/monthly meetings with brokerage firms 'ex. Marsh, Nasco, WTW, deraya, Medmark, HIB … etc'
- Face to face communication with individual/retail clients
- Leading health claims communication with FRA
- Approving/rejecting high value claims, case management
- Manage a team of medical professionals responsible for evaluating medical assistance requests.
- Leading Health claims complaints and liaising with other departments
- Assure complete, accurate, clarified solution
- Support new team members and build up their training plans
- Manage internal training sessions to other departments (ex .Call center, complaints teams …)
- Ensure the team objectives are met throughout the year
- Health claims Customer relations senior officer (From April 2021 till Jan 2023)
- Senior medical reimbursement claim officer (From March 2020 till March 2021)
- Medical reimbursement claim officer (from August 2018 till Feb 2020)
- Part of Team Building New Ticketing System with all work flow (internal departments, auto-replies, SLAs, …)
- Part of Team Building New reporting/Handling health claims communication Unit
- Coordinated with management to develop strategies for improving overall team performance and delivering exceptional customer experiences.
- Maintained excellent relationships with key accounts by providing prompt, personalized service at all times, resulting in increased client retention rates.
- Collaborated with other departments to address complex customer issues, ensuring prompt resolutions and mutual satisfaction.
- Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
- Trained new personnel regarding company operations, policies and services.
Quality Control/Quality assurance - Analytical Science and Technology Analyst
Novartis-Egypt
07.2016 - 07.2018
- Responsible on Global raw material validation project in Egypt
- Responsible on organizing, assuring safe storage for stability Products
- Global communication, agreements internally/externally and finalizing Raw material validation updates for the Laboratory
- Responsible on controlling the HSE rules in the AS&T lab
- Issuing official Validation protocols
- Learning and applying Validation equations
Customer Consultant - UK
Bupa Global
07.2015 - 06.2016
- Handling International customer queries regarding international health insurance
- Revising Medical claims queries
- Revising Eligibility of coverage of certain medical conditions
- Auditing and solving inaccurate processed medical claims
- Ensuring accurate and fast replies within agreed SLA
- Full investigations related to complaints
- Assisting in coaching customer care medical claims team
- Keep up to date with all policy terms and conditions
- Issuing pre-authorizations
- Enhanced customer satisfaction by addressing and resolving inquiries promptly and professionally.
- Managed escalated issues efficiently by coordinating solutions across teams when necessary.
- Streamlined communication channels between departments, ensuring timely resolution of customer inquiries.
- Oversee the evaluation process for medical assistance requests, ensuring timely and accurate assessments.
International Medical interviewer
IMS Egypt (IQIVIA NOW)
11.2014 - 02.2015
- Handling international Medical/Drug market research via calls and emails
- Organizing, Collecting and Ensuring full accurate data
- Repairing marketing studies and research, analyzing data, and compiling the necessary statistics to support decision-making in marketing.
- Discussing Medical information with Egyptian/Non-Egyptian providers
- Gathering data and information regarding competitors' service prices and presenting them to the direct manager to assist in the hospital’s service pricing process.
Education
High School -
Salam Language School/Saint Fatima
Assiut, CairoBachelor degree - Pharmacy & Biotechnology
German University in Cairo
Cairo, Egypt01-2014
Skills
Training and mentoring
Training
- 07/12, Sanofi Aventis, Non Sterile Production Area
- 2012, Community Pharmacy
- Online Training Project: Management (PMP), Communication Foundation
Activities
- Was Studying Music at Fabrica Under the supervision of Soprano Opera Singer, Dr. Neveen Allouba.
- Working to be committed to Fitness plans.
Interests
People oriented
Music
Singer
Singer
Studies Music at Fabrica Academy with Dr. Neveen Alloba
Timeline
Health claims Customer relations Team Leader - Reimbursement Unit
Axa Egypt
08.2018 - Current
Quality Control/Quality assurance - Analytical Science and Technology Analyst
Novartis-Egypt
07.2016 - 07.2018
Customer Consultant - UK
Bupa Global
07.2015 - 06.2016
International Medical interviewer
IMS Egypt (IQIVIA NOW)
11.2014 - 02.2015
High School -
Salam Language School/Saint Fatima
Bachelor degree - Pharmacy & Biotechnology
German University in Cairo
Similar Profiles
Nada Ahmed RabieNada Ahmed Rabie
Senior investment analyst at AXA EgyptSenior investment analyst at AXA Egypt
Mohamed Abou AlamMohamed Abou Alam
P&C Sales And Partnerships Director at AXA EgyptP&C Sales And Partnerships Director at AXA Egypt
Asmaa IsmaelAsmaa Ismael
Office Administrator at AXA EgyptOffice Administrator at AXA Egypt
Mohamed SalamaMohamed Salama
Regional Sales Manager at Unilever Middle EastRegional Sales Manager at Unilever Middle East
Mohamed KhaledMohamed Khaled
Head Of Sales Management at Midea Electrics EgyptHead Of Sales Management at Midea Electrics Egypt