HEALTHCARE CLAIMS ADMIISTRATOR
AXA INSURANCE GULF
مجموع سنوات الخبرة :9 years, 11 أشهر
Advises management of potential areas of improvement for loss control by removing the waste
• Searches for opportunities to pursue indemnification, contribution or subrogation while reviewing claim files
• Handles and resolves complaints and problems arising out of daily operations of the department
• Assess the accuracy and efficiency of claims management strategies, and provide feedback and recommendations
• Administering the HAAD & DHA E-claims (200K/month), submissions and uploading the Remittance
Advice (RAs) on the portals, ensure to achieve the TAT of Health authorities
• Validation of DHA, HAAD, Qatar, Bahrain & Oman E-claims and rectify their technical issues
• Conversion of Physical claims in E-claims with ICD codes (Medical coding)
• Physical/Email claims registration (Direct Billing, Reimbursement and International claims)
• Scanning of the documents, archiving and retrieval, cheque dispatching to providers and members
• Answering all customer queries in a timely and efficient manner through CRM
ADMINISTRATIVE AND CUSTOMER SERVICE
• Performed variety of customer service and administrative tasks to resolve customers’ issues quickly and
efficiently. Assist the line departments i.e. Customer Service, DB Processing, RI Processing and Medical
Board departments on medical claims inquiries.
• Answers a high volume of incoming calls and emails while handling in person inquiries from providers and
members. Participate in individual and team development activities/training to maximize both individual
and team performance.
• Developing and maintaining strong relationships with broker clients to ensure that we retain post
retirement business and not lose it to our competitors (Annuities and ARFs)
POLICY ADMINISTRATION
• Managing post-sale data of beneficiaries according to census management at policy inception level,
addition and deletion of membership cards and making sure the all the policies adhere to DHA and MOH
guidelines and dispatched to the customers.
INTERIM RESPONSIBILITIES:
• Managing the team of 12 team members, ensuring to meet the TAT and SLAs of all processes
• Generating MIS reports for higher management to review the overall department progress
• To supervise team regarding payment and filing CST teams, carrying out regular team meetings as well as
assisting the Regional Claims Manager with a variety of administrative tasks as required
• Making desktops (presentations) for higher management regarding the KPI’s;
Provide a variety of administrative functions, which include administrative support for one or more executives, phone coverage, reading and routing incoming mail, scheduling appointments and processing expense reports
• Providing HR related task to Senior Projects manager and Administration Manager, designing advertisements, short listing of applicants and conducting initial/telephonic interviews • Compose and organize materials and reports, and maintain records for work performed • Worked closely with the team to collect and collate data on progress measures; tracking service delivery, suppliers and contractor database, and review documentation of all projects • Provided regular progress reports with narrative for the projects, real estate teams and senior management • Defines and implements systems and methods. Coordinates processes that support the team in continuous improvement of project delivery and achieving maximum productivity • Carries out project related administration such as scheduling tasks and producing/ filing general documentation as required • Builds and maintains effective relationship with the team, partners, suppliers and contractors • Collaborates with suppliers to assure the quality of their products, materials, components and operations • Monitors supplier performance and costs on a quarterly basis and supports efforts to develop and implement changes to improve the production process • Negotiates favorable terms, volume discounts and long-term contracts with suppliers • Prepares and processes requisitions and purchase orders for the procurement of projects and facilities • Reviews purchase order claims and contracts for conformance to company policy and discusses defects and delivery problems with suppliers and negotiates refunds
• Created Excel spreadsheets to summarize financial activity for projects, invoices, and balances and tracking the performances of site, design department and supervisors;
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