Insurance Department Mnager
Mezyad Medical Center
Total years of experience :3 years, 9 Months
• Organizing & conducting negotiations process with regards to contracting and SPC factors with various insurers to reach a satisfying result for all parties involved according to M/s. HAAD rules and regulations.
• Review all medical records, contacted insurers on any noted issues or concerns and successfully prepared all prepared claims submission files.
• Prepared and conducted orientation and training sessions to our facility physicians/staff concerning updates in insurer’s policies and new regulations in health industry.
• Handling prior approvals from physicians for patients utilizing our centre services according to their health insurance policies with various insurance providers and obtaining all necessary documentation to insure approval of the same and accurate billing.
• Supervision of processed bills and invoices and forwarding the same to accounts department on a monthly report of submitted claims/amounts.
• Collaborated with IT programmer on system conversions and issues.
• Contributed to the development of marketing plans and strategies by draft writing, design, and preparation of marketing materials
• Monitored competitors marketing activity and delivered sales statements to higher management.
• Maintaining a healthy and productive business relation through excellent communications skills with all contracted health insurance providers to insure stable work fluency.
• Assisted in Customer Service activities explaining to complaining patients their insurance policies and scoop of coverage to resolve any arising conflict.
• Addressed and reacted appropriately to personnel and physicians concerns/compliments relative to insurance department operations.
please review the attached CV
• Review of received medical reimbursement claims with technical and medical point of view to estimate reimbursement legitimacy, registering claims in a high developed system program.
• Provide assistance obtaining prior approvals for procedures requiring the same avoiding any future inconveniences.
• Provide clients with periodic utilization report, updated claims status, and updated lists of network providers as received from underwriters.
• Review of health insurance policies, P/A policies, and schedule of benefits; prepare an easy handled analysis of different quotations in order to reach a satisfactory coverage at a reasonable premium.
• Fast and adequate replies for any health insurance related query.
• Finalizing the analysis with a professional recommendation letter compliant to the client requirements.
• Strong and periodic follow up on outstanding issues in between clients and underwriters.
• Power point presentations of purchased insurance product in order to educate clients efficiently utilize the policy while maintaining a reasonable loss ratio.
• Client care management by standing as a negotiator on behalf of clients with insurance companies to resolve any outstanding issues.
• Regular meetings with clients, brokers’ relation channels/teams of underwriters to maintain a high level of confidence and liability enabling to reach amicable solutions in conflict situation.
• Monitoring performance of underwriters /clients as throughout policy year to be a step ahead at the renewal due date.
Bachelor’s degree in medical science (MD) general practitioner 1999- Vitebsk Medical University- Belarus. Internship according to standard MOH programme of republic of Belarus 1999-2000.