Medical Underwriter in Allianz Saudi Fransi
Allianz Saudi Fransi Cooperative Insurance Company
Total years of experience :16 years, 1 Months
Presently working as Medical Underwriter in Allia nzSaudiFra nsi Coope r a t ive I n sur a n ce
Company, started work since 06 February 2012.
Job profile: Receive request from the client as a proposal form, study the requirements thoroughly.
Issuance of quotations on daily basis, by using sophisticated quotation tool.
Prepare renewal terms prior to 30 days of expiry date.
Policy issuance, Processing work, CCHI uploading, endorsements, policy admin and other
tasks as required.
Establish the loss ratio of existing insurance policy.
Coordinate and manage the day-to-day operation of medical insurance policy logistics
Coordinates with the sales team to gain prospective clients. And close business deals.
Establish strong relations with brokers and clients.
Generate all kind of reports on business portfolio ( New, Renewals, Expired, Members list,
CCHI Accepted & Rejected members lists)
Follow all the guidelines as per CCHI regulations.
Billing of endorsements and due quarters.
Technical / Functional Skills: 1) Excellent command on AllianzSF (IMS System & WorkFlow portal), MedNet system
(MedNexti) & Saudi NextCare (TATSH)
2) Excellent relationship management skills.
3) Ability to manage and prioritize work load.
4) Proficient in Microsoft office.
5) Fluency in verbal and written (Arabic & English)
6) Flexible approach to work, initiative, and attention to details.
7) Coordinates with the sales team to gain prospective clients.
Behaviors: 1) Maintains awareness of market developments including legal (CCHI & SAMA
regulations) and technical issues.
2) Understands & acts on key customer needs.
3) Ability to persuade, influence & negotiate.
4) Ability to manage conflict and extend empathy to the subordinates involved.
5) Performs consistently under pressure.
6) A good learner.
Company: Worked as TPA Accountant for GlobeMed Saudi Arabia,
Since 13/04/2008 till 05/03/2012.
Job profile: Managing and setting up of the claims processing with Quality Assurance from A to Z as
per the requirement / priority
Monthly confirmation of credit to the providers for the claim settlement.
Meetings/correspondence/negotiation of claims with providers and reconciliation of accounts
Maintain data base of administration of claims payment.
Preparing various types of management reports associated with claims.
Negotiation of discount and price list with providers.
Formulate agreement with providers for credit service.
W ork Flow
Receiving of claims in the department by date received wise after completing all the stages i.e. coding, data entry and checking. First we check if those particular claims
are registered to its months and respective hospitals ..than we scrutinize claims by
Plan review
Plan inclusion / exclusion
Effective date of membership / terminations.
Verifying eligibility
Identifying duplicate charges.
Checking approvals & second opinion.
Calculating payable benefits.
Corresponding with hospitals for medical reports, discharge summaries.
As Coordinator: -
Meet schedules, plan and organize work.
Communicate effectively both orally and in writing.
Read, apply and explain rules, regulations, policies and procedures.
Problem Solving/Analytical Skills
Interpersonal / Communication skills
Organize, maintain and operate
Provide specialized assistance and information concerning claims and policies
Work independently using effective public relations skills with little direction.
Determines the insurance policy coverage, diagnosis, clinical and testing
prerequisites, limits of coverage, patient responsibility, referral, pre- authorization requirements, etc.
Certification of IFCE from Institute of Banking.
Certification of Higher School, grade Good Certification of Diploma in Pharmacy from Technical institute For Health Training with ratio 3.43. Certification of BLS From Al Farabi Colleges. Training course in Pharmacy at P.M.M.H. from 21 May 2006 to 13