Director of Health Underwriting
Al Rajhi Takaful
Total years of experience :18 years, 3 Months
Leading and heading the health line of business P&L
Feb 2011-Now Medical Underwriting Manager - Commercial Finance Dept.
BUPA Arabia -Jeddah, Saudi Arabia
• Reporting directly to Head of pricing and actuary department.
Responsibilities;
• Ensures achievement of positive technical results through high-quality and cost-efficient transaction.
• Responsible for achieving positive technical results through individual and group underwriting according to state of the art underwriting guidelines. 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.
• Develops implements and continuously revises policies & procedures for Underwriting, product development to suit the business objectives of the department in the company.
• Ensures that Policies & Procedures have been approved updated coordinated and integrated with the overall Processes, Policies and Procedures of the organization
• Defines functional performance management structures and mechanisms for systematic improvement of the department in the company
• Manages daily operations of the underwriting in a way that ensures achievement of departmental goals as defined.
• 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. Develops direct health insurance products/solutions which support business growth of the company (Corporate, SME and individual)
• Preparing reports requested by senior management and produce ongoing underwriting reports. Defines the strategy for the underwriting department and the annual goals of the underwriting.
• Sets annual goals which support the pricing department strategy
• Steers growth of business by supporting development of new and continuously enhancement of the existing health insurance product portfolio
• Provide underwriting knowledge sharing to peers across the organization.
• Ensures transparency of department activities.
• Plan, execute and contribute to other projects and duties as assigned
• Member of Antifraud and risk management committee, providers’ analysis work group and clinical governance committee within BUPA Arabia.
• Monitoring and controlling of technical performance (Quality Assurance)
• Manages and accountable for underwriting, product development
• Ensures that internal & external communication requirements are being adhered to in a timely and professional manner (Quality Assurance)
• Provide expertise and support to other departments.
• Trains appropriate candidates joining the commercial finance department or the organization.
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
• 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.
Certified Medical underwriting Specialist (CUS) Chartered Insurance Institute (CII). Jan 2013-Mar 2014. The course takes place in Gen Re business school, Cologne, Germany The CUS certificate programme consists of 4 modules that systematically address the life/critical illness and disability underwriting.
• TQM Total Quality Management diploma in healthcare American university of Cairo (AUC) – KSA Branch Nov.2008 – Dec.2009 The diploma consists of 5 modules; 1. The basic Six Sigma: Breakthrough Improvement Process. 2. Managing Information in healthcare. 3. Quality/Environment System Standards in healthcare. 4. Improving and Organization Performance. 5. People Management.