Ahmad Al Shaer

Heading and leading the underwriting / pricing department.
Plan and monitoring the execution of the company health LOB strategy.
Directing the lean transformation and the change management
Product development and enhancement.
Financial planing and budgeting

Heading the Health line of business P&L

Heading the health underwriting and pricing function to empower profitability and to secure sustainable profitable growth to achieve Al Rajhi takaful strategic goals.

Direct reports (PA, Customer care, Reimbursement, Healthcare partnership, Healthcare portfolio management Deps)
•Ensuring the delivery of a first class customer experience to all of our stakeholders (customers, providers, brokers and clients)
•Develop /improve a departmental SLA &TAT to enrich the customer experience
•Work in partnership with stakeholders, in an area to ensure coordinated service delivery and to improve both quality and output.
•Managing key account's loss ratio by their claims experience;by proactively providing the clients with insights and actions to the most appropriate treatment with the best cost effectiveness
•Improving the experience and driving retention, satisfaction and brand awareness.
•Creates a monitoring dashboard to understand the trends of utilization, consumption with clear warning signs.
•Identifies the nature of risk (health risk indicators, member fraud, provider over utilization) with the KAM, broker and client’s contact point on corrective actions to protect the client from excess claims
•Transforms data in a meaningful format to the customers to set a group of actions to proactively manage the group performance from commercial, healthcare aspects
•Integral part of the renewal process with the group, where value adding for accounts, with the group KAM to increase the retention rate
•Build strong partnership/affinity with the key contacts in each group by being the reference point for their medical /service query
•Detecting the major HVC(cancer cases, new born, RTA..)making sure the best medical management with the best cost effectiveness providers
•Works closely with healthcare partnership, procurement and marketing on designing and implementing tailor made programs for groups to support the profitability and retention
•Researches, identifies, develops and manage new program partnerships/wellbeing based on the needs
•Assists in a corporate partnership strategy that will consist of marketing, communications, employee engagement

• Assessing the risks and other terms provided and decide the price accordingly to accept the group (corporate, SME and individuals) protection liabilities and approve acceptance of new business.
• Review the customer’s specific information including employee demographics, carrier history and study the claim experience to determine the risk, potential benefit features and premium rates for insured groups.
• Analyzing the providers’ behavior across the networks in terms of medical cost and frequency with member exposure.
• Assist in the negotiation of benefit plan designs financial assumptions with sales team on new and renewed business.
• Preparing reports requested by senior management and produce ongoing underwriting reports.
• Provide underwriting knowledge sharing to peers across the organization.
• Member of Antifraud and risk management committee, providers analysis work group and clinical governance committee.
• Conducting training to the new joiners in different departments

Reporting directly to Preauthorization Manager

Responsibilities (as part or Preauthorization Team):
• Adjudicate all requests received from the providers’ regarding BUPA policy & medically.
• Case management.
• Member of Bupa quality team (raising quality of processes increasing efficiency, scoping customer satisfaction and members loyalty)
• Cost control.
• Ensure proper services delivery.
• Fraud detection.
• Anti selection detection.
• Act as part of medical help line, customer services & loyalty program.
• Medical underwriter(Pricing team), Risk analysis &management.

• Reporting directly to Group Medical Officer.

Responsibilities:
• Medical consultation, examination, diagnosis & treatment.
• Responsible of handling medical claims.
• Act as hot line advisor for any emergency call or questions regarding ALICO’s medical network.
At:
Kraft Food Industries, Johnson&Johnson Egypt, Mentor Graphics, British American Tobacco (BAT), Lucent Technology, AUC, PepsiCo, PGS, Orange Telecom, TAV, NTRA, ABB, Olympic Group, ALKAN Group.