Claims Processor Medical & General Insurance
Arabian International Steel structure
Total des années d'expérience :20 years, 11 Mois
PERFORMANCE PROFILE
Highly ambitious and hardworking medical claims processor with 15 years of extensive experience of coding and processing claims accurately and timely entering, reviewing and resolving simple to moderate complexity medical claims in accordance with set policies, procedures and guidelines. Proficient in entering claims data into predefined systems while interpreting coding in relation to diagnosis and procedures.
Highly organized, able to review and analyze claims through the utilization of available resources. Analyzes and applies plan concepts to claims including deductibles, coinsurance, co-pay and out of pocket costs. Effectively examines claims to determine if further investigation is required from other departments.
Substantial knowledge of medical terminology, CPT codes and ICD-9 codes.
Professional Competencies
Claims Routing ✓ Data Entry ✓ Claims Review
Process Improvement ✓ Data Confidentiality ✓ Resource Management
Coding Interpretation ✓ Adjudication of Claims ✓ CPT Coding
EDI Processing ✓ Medical Terminology ✓ Demographic Updates
PROFESSIONAL EXPERIENCE
EMPLOYMENT PROFILE:
Company : Arabian International Company (AIC) RAK - UAE & KSA
Job information : Medical & General Insurance Specialist - Administration
Employment Term : Permanent
Industry : Steel Structure/ Construction/Engineering
Review received claims for accuracy and ensure that their eligibility is verified
Identify processing deficiencies and initiate corrective actions according to specified instructions.
Analyze and apply plan concepts to claims such as copays, deductibles and coinsurances
Claim diagnosis review as per ICD and CPT code.
Examine each claim to determine if any further intervention is required, and submit the claims through the Insurance office.
Resolved problems resulting from claim settlement
Performed audit of randomly selected claims to ensure quality processing
Followed adjudication policies and procedures to make sure proper payment of claims
Ascertain that all claims and patient demographic information is confidentially maintained
Compose and send letters of explanation regarding claims issues and policy provisions
Maintains overall responsibility for day-to-day management of claims processing operation Medical & General Insurance
Reviewing the Concern Insurance all Policies including Medical & General Insurance.
Review all Quote and Comparison, Processing of all Insurance Claims + follow-up for Receivables Department for payment settlement.
Improved advanced Billing System Insurance Management.
Managing the Company clinic activities for the workers medical and accident cases.
Provided timely customer service to members, providers, billing departments and other insurance companies on the subject of claims
Answered inquiries from members on the subject of claim, eligibility, covered benefits and approval status issues.
Co-ordinate with TPA & brokers for solving the issue with hospital & clinics.
Contacted insurance companies to determine statuses of admitted claims, and recorded all derived information
Career Objective:
Seeking a challenging position in a dynamic organization which can utilize my potential skills to its full extend and where there is a need to share cooperative efforts through sound planning, creativity especially in “Medical &All Risk Insurance, Aramco Billing affairs, Administration Management, HR.Dept, for all round development of the company, within time constraint in a professional way.
I am a highly motivated Team Leader with good Medical & All Risk Insurance technical and ethical skills and experience has been built on a strong experience background in “Medical &All Risk Insurance & Administration” Aramco Medical affairs services, Administration, Health Sector, HR.Dept and Finance. My skills include an excellent planning and communication level where I use my experience to have a global perspective of the company I work for.
As Specialist Insurance to use the Valuable basis by utilizing strong interpersonal communications, organizational and presentation skills. And able to work in the field of “As Administrator in Medical, General Insurance, Administration & HR”.
PROFESSIONAL EXPERIENCE
EMPLOYMENT PROFILE:
Company : Arabian International Company (AIC) RAK - UAE & KSA
Job information : Medical & General Insurance Specialist - Administration
Employment Term : Permanent
Industry : Steel Structure/ Construction/Engineering
Review received claims for accuracy and ensure that their eligibility is verified
Identify processing deficiencies and initiate corrective actions according to specified instructions.
Analyze and apply plan concepts to claims such as copays, deductibles and coinsurances
Claim diagnosis review as per ICD and CPT code.
Examine each claim to determine if any further intervention is required, and submit the claims through the Insurance office.
Resolved problems resulting from claim settlement
Performed audit of randomly selected claims to ensure quality processing
Followed adjudication policies and procedures to make sure proper payment of claims
Ascertain that all claims and patient demographic information is confidentially maintained
Compose and send letters of explanation regarding claims issues and policy provisions
Maintains overall responsibility for day-to-day management of claims processing operation Medical & General Insurance
Reviewing the Concern Insurance all Policies including Medical & General Insurance.
Review all Quote and Comparison, Processing of all Insurance Claims + follow-up for Receivables Department for payment settlement.
Improved advanced Billing System Insurance Management.
Managing the Company clinic activities for the workers medical and accident cases.
Provided timely customer service to members, providers, billing departments and other insurance companies on the subject of claims
Answered inquiries from members on the subject of claim, eligibility, covered benefits and approval status issues.
Co-ordinate with TPA & brokers for solving the issue with hospital & clinics.
Contacted insurance companies to determine statuses of admitted claims, and recorded all derived information
I am looking job in fiedl of Accounts, Administrative, Medical Insurance.Billing, Human Resource.
Position HUMAN RESOURCE COORDINATOR
Company Sameer Ibrahim Saeedi General Hospital Yanbu Al -Baha, Kindgom of Saudi Arabia.
Period March 12, 2013 up to Nov 01, 2013.
Duties & Responsibilities: Under the direction of the General Director and Administration Manager, it is responsible for maintaining HR Department & Personnel Records and performs other clerical work related to the Administration & Personnel function.
➢ Assist the Human Resources Manager to create and continually update Personnel Policies & Procedures for the section.
➢ Raises personal file numbers for each and every new employees.
➢ Maintains confidentiality of personnel records. Keeps all personal files under strictly security and allows access to the files for authorized personnel. Maintains a separate record of all government issued documents, including dates of issue and expiry. Arrange with the employees to produce documents requiring renewal, on time to avoid Penalty. Records all renewals and dates.
➢ Responsible to keep updated record of Iqama, Work Permits and Passports details in the system.
➢ Prepare the staff list, reports and salary analysis reports required by the Personnel Manager.
➢ Coordinate with all Departments including Finance with regard to pay roll and immigration charges.
➢ To develop and maintain and efficient and accurate Central Personnel Record System.
➢ Raises personal file number for each and every new employees.
➢ Makes flight bookings for employees leaving the kingdom on vacation or termination of contract in accordance with approved leave schedules and procedures. Obtains flight tickets from the travel agent. Requests transportation to deliver employees to and collect them from Airport.
➢ Preparing documents and send new employee for Medical Check Up / Malaria Check Up. Coordinate with Transport Supervisor for follow up to obtain the reports.
➢ Prepare Staff Referral forms for medical and self correspondence in day to day letters.
➢ Responsible for employees finger print scanning to register their daily attendance.
➢ Verifying Overtime forms from various departments and forwarding Finance Department after approved by General Director.
➢ Prepare Material Request as if it is needed.
➢ Perform other duties as assigned by the Human Resources Manager
Worked as Aramco billing coordinator and Assistant Aramco Laision physician.
Follow all billing aspects with aramco accounts affairs.
updating and monitoring of all registered clients.
reported to the management for any futher management.
updated all daily patient information report to the Aramco Laision Physician.
Assist the patient for the requored servikces through SAHL system.
all other worked according to the under management operation.
Job information: Aramco Billing Coordinator/ HR Coordinator
Employment Term: Permanent
Industry: Health Services Sector
Key Skills: Receivables Department, Advanced Billing System
Insurance Management, Insurance Policies Updating.
Total Experience: More than 12- in various areas of Accountancy and
Administration, HR.Dept, Insurance services And Patient Billing.
(Jan 19, 2002 - till present)
I. Professional experience: (12 Years Experience)
II. Experience in various areas of Accountancy and management. Having a good track record in accounts receivables, accounts payables.
Position PERSONNEL COORDINATOR
Company Sameer Ibrahim Saeedi General Hospital Yanbu Al -Baha, Kindgom of Saudi Arabia.
Period March 12, 2013 up to Nov 01, 2013.
Position Held: Aramco Billing Coordinator
Period: Sep 23, 2010 to Feb 11, 2013
Location: Sameer Ibrahim Saeedi General Hospital
Yanbu Al -Bahar
Job information: Aramco Billing Coordinator/ HR Coordinator
Employment Term: Permanent
Industry: Health Services Sector
Key Skills: Receivables Department, Advanced Billing System
Insurance Management, Insurance Policies Updating.
Total Experience: More than 12- in various areas of Accountancy and
Administration, HR.Dept, Insurance services And Patient Billing.
(Jan 19, 2002 - till present)
I. Professional experience: (12 Years Experience)
II. Experience in various areas of Accountancy and management. Having a good track record in accounts receivables, accounts payables.
Insurance Management, Insurance Policies Updating.
Total Experience: More than 10- years of experience in Medical
Insurance services And Patient Billing.
(Jan 19, 2003 - April 15 2010)
Company: Yanbu National Hospital
Company Profile:
Al Mutabagani Health Services Pvt Co Ltd is well known company in providing the Health Services. It has more than 50 projects in the Kingdom and most of the project were working with One of the Top Oil Company in the world ie SAUDI ARAMCO and Yanbu National Hospital is a Unit of Al Mutabagani Services Co Ltd, which also dealing with ARAMCO, NCCI - Tawuniya, Medivisa, Mednet, Bupa and many other Insurance & direct companies.
Job Responsibilities:
➢ Super User of SAHL (Saudi Aramco Health Link) to manage all the related Accounting & Billing Processes in ARAMCO Company dealings.
➢ Mainly the Accounting procedures of SAHL Billing are being handled to fulfill the requirement of our Valuable Contractors.
➢ Good Knowledge E-services provided by the Insurance Companies like TAWUNIYA & MEDGULF through WASEEL, BUPA Portal, CARS INS. SAICO, etc.
➢ Responsible for meeting sales goals and overall quality of service
➢ Developed and implemented plans for strategic accounts that exceeded expectations in revenue retention/growth, account profitability, and customer satisfaction
➢ Monitored new account success by contacting customer at scheduled intervals. Ensured customer program satisfaction
➢ Pursued long-term account strategy that maximized profits and assisted in cultivating long-term relationships with the appropriate decision makers
➢ I am in charge of commercial relationships management, from first contact to bid and contract preparation. I personally manage the company's key account, having great autonomy inside a budget negotiated with the general management.
➢ My compensation is strongly based on objectives Making the Contract Agreement between Hospital and Insurance Companies.
➢ Implementing new ideas and suggestion related to Billing System for profit measures as per contract with cooperation of our IT Team.
➢ Well professionalized action to improve healthcare business.
➢ Good Communication talent over English / Arabic for helping all type of customers.
➢ Maintained all record and update policies of all Direct and Insurance Companies in the HMIS (Hospital Management Information System)
Abilities: ➢ Strong communication skills in all forms including written, oral, email, telephone, and presentation To perform as a Team Member in a Large Multidisciplinary group.
➢ Excellent organizational and time management skills.
➢ A sound understanding Health Sector services would be a distinct advantage Functional Competencies required
➢ Ability to manage and maintain accurate and accessible tailored documentation i.e. Presentations / proposals to meet clients needs.
➢ To use computer for competence record of profiles of the Insurance Companies and Details of Patients. (Word for Windows, Excel, Power Point, etc.)
➢ To resolve conflict and ready to work under pressure.
➢ To apply advanced techniques to assess market opportunities.
➢ To create new Executive strategies in a dynamic way to expand service offerings.
Interpersonal skills:
➢ Communication skills - verbal and written
➢ Listening skills
➢ Problem analysis and problem-solving
➢ Attention to detail and accuracy
➢ Data collection and ordering
➢ Customer service orientation
➢ Adaptability
Worked as Aramco and Medical Insurance Coordinator.
Updated all the patient information in aramco system.
Updated the Regisistered patient and provide the required services.
Expers user of Waseel for updated all requested services to the patient to get approval from said insurance companies.
Follow all billing invoices with the finance department for finalized the invoice.for Inpatient and Ot patient.
Other work as assigned by department Head and management.
➢ Bachelor of Education. (B.Ed) ➢ Certificate in Computer Education - NIIT - Nagpur. Typewriting English -60 W/m - Technical of Education - Pune PERSONAL SKILLS & ABILITIES: ➢ Ability to work in fast changing environment. ➢ Willingness to work flexible hours. ➢ Motivate and committed to excellence. ➢ Can organize work skillfully and efficiently. ➢ Can-work under ordinal with superiors and colleagues. ➢ Positive attitude.
➢ Initiative ➢ Stress tolerance ACADEMIC QUALIFICATIONS: ➢ Bachelor of Arts - Major subject - English- History-Phy.Education. Marathwada University (Year: 1993 -1996)