Director of corporate strategy
Saudi German Hospitals UAE
Total years of experience :26 years, 5 Months
• Identify opportunity, Create strategies and drive the business to attain goals.
• To liaise with AccuMed clients, through developing and managing healthy relationships
• Establish and build productive associations with all the payers/TPA’s in the UAE.
• Work closely with the Operation team to provide external feedback and support which is needed to ensure excellent service delivery to clients.
• To lead on projects/solutions that will reduce cost, maximize efficiency and add value to clients.
• Manageentirely AccuMed Billing unit including sales, marketing & full operations.
• To effectively solve problems, manage risk and ensure achievements of targets.
Responsibilities:
Human Capital Management
• Manage the effective achievement of the medical department objectives through setting individual objectives, managing performance, developing staff and providing formal and informal feedback in order to maximize overall performance and team motivation.
• Deliver training to existing and new staff members in order to improve their knowledge and ensure their professional development.
• Supervise and provide the necessary guidance to the Medical staff in order to ensure that they appropriately fulfill their duties and responsibilities as per the established standards.
Budgets and Plans
• Prepare and recommend the department budget and monitor financial performance versus the budget so that the business is aware of anticipated costs/ revenues, and areas of unsatisfactory performance are identified, rectified promptly and potential performance improvement opportunities are capitalized upon.
Medical Management
• Plan and manage the overall operations of the medical department in order to ensure achievement of optimum customer satisfaction with the medical review services in accordance with established quality parameters and Munich Health policies and procedures.
Medical Coding
• Ensure medical claims teams are expertly trained on use of medical coding and follows the medical coding standards as per regulatory directives.
Medical Authorisation Activities
• Manage and provide overall guidance and leadership to the claims review, evaluation and authorisation activities ensuring compliance with established policy guidelines.
• Manage the effective review of all claims processed by the claims department in order to ensure the incorporation of the medical point of view on such claims.
• Lead and manage the effective evaluation of in-hospital cases in respect of medical necessity and appropriateness and provide approval of benefits as per the policy wordings and based on medical point of view.
• Creating P&P for all relevant processes in the division (underwriting, claims & customer service).
• Reconstructing the job description & responsibilities for the staff in the division.
• Developing new products based on market/clients requirements.
• Managing the division from the technical & administrative perspectives.
• Meeting with clients/brokers/agents together with sales staff to present the benefits of our products and propose medical coverage.
• Prepare and submit to the GM the Department business plan report (strategy, human resources and capital budget of the Department).
• Participates in preparing the annual plan.
• Suggest to Direct Upper Line of Authority improvements in the policies and procedures of the Department and
• Meet with the Department staff to discuss operations and staff performance.
• Determine the training needs of the staff and inform Direct Upper Line of Authority and takes responsibility to see that the training is carried out.
• Assist in the in-house seminars and training courses.
• Attend seminars as per approved annual budget.
• Produce periodical reports analyzing the Department's overall operations.
• Study and comment on medical assurance proposals.
• Study and comment on Renewal and Add/ Deletion requests.
• • Overview requests regarding changes in Assurance terms and relevant endorsements prepared.
• Control the activities and performance of the Medical employees.
• Prepare studies for new medical programs/policy wordings.
• Undertake correspondence with the Re-insurers and the external actuary regarding the new medical programs proposed.
• Overview the treaties terms, structures and negotiations with Re-insurers.
• Solve problems encountered in day-to-day medical operations and take corrective and preventive action.
• Review all periodic reports of the Medical Department.
• • Suggest action plans to keep up with required growth and profitability.
• Creating P&P for all relevant processes in the division (underwriting, claims & customer service).
• Creating work flow chart for each and every particular process in the division (underwriting & claims).
• Developing new products based on market/clients requirements.
• Managing the division from the technical & administrative perspectives.
• Meeting with clients/brokers/agents together with sales staff to present the benefits of our products and propose medical coverage.
• Prepare and submit to the GM the Department business plan report (strategy, human resources and capital budget of the Department).
• Participates with the GM to prepare the annual plan.
• Meet with the Department Supervisor to discuss operations and staff performance.
• Determine the training needs of the staff and inform Direct Upper Line of Authority and takes responsibility to see that the training is carried out.
• Assist in the in-house seminars and training courses.
• Produce periodical reports analyzing the Department's overall operations.
• Study and comment on medical & life assurance proposals.
• Study and comment on Renewal and Add/ Deletion requests.
• Approve the notification letters to clients regarding policies renewal.
• Overview requests regarding changes in Assurance terms and relevant endorsements prepared.
• Present studies to the GM regarding life and death claim.
• Approve the life claims notifications and settlements within authorities.
• Prepare the life valuation in coordination with the external life actuary.
• Check the external life actuary valuation certificate.
• Control the activities and performance of the Medical & Life employees.
• • Undertake correspondence with the Re-insurers and the external actuary regarding the new medical & life programs proposed.
• Overview the treaties terms, structures and negotiations with Re-insurers.
• Review all periodic reports of the Medical & Life Department.
• Contacting with our client in the region (M.S, McDonald....) in order to maintain our business and respond immediately to their queries and requests.
• Provide medical and insurance advice to the operation department in order to decide the coverage for some cases with huge estimated cost.
• Tailoring and finalizing the new products in accordance with the regulations of insurance law in Abu Dhabi which is monitored by Health Authority- HAAD.
• Meeting with new clients together with sales staff to present the benefits of our products and propose medical coverage.
• Check the compatibility of the additional requested coverage in accordance with the regulation of the insurance law in Abu Dhabi.
• Following up the renewal/cancellation of the existing policies in coordination with all concerned departments (sales, production, finance...) to ensure that it happens on time without any delay.
• Review the policy wording as well as all endorsements for our products to ensure that sufficient information reflecting the contract with the policy holder is included.
• Weekly report to the V.P to summarize all activities, meeting and new products.
• Meeting with new providers (Hospitals, Policlinics...) to include them into our network and negotiate the discount on their tariff.
• Finalize the annual reconciliation with providers in order to get additional discount based on the business volume.
• Recruiting all staff (170 employee) of the claims department (MROs:Doctors, MCPs:Pharmacists, Dentists & some others with insurance background).
• Prepare the P&P, work flow and organization chart of the department.
• Prepare the budget, manpower plan and monitor the implementation of the board recommendation.
• Prepare the KPI of the department and monitor the performance on departmental level.
• Prepare the appraisal, promotion and handling all administrative issues in accordance to the company's policy & values.
• Review the policy wording for products in accordance to the new insurance law had been implemented in emirate of Abu Dhabi.
• Conduct a presentation on the new products to sales staff in order to ensure that sufficient information will be promoted in the market.
• Approach the key clients (Etihad Airways, ADNOC, Amiry Flight, GAMCO, Mubadala...) together with sales staff to present the coverage of the product and answer any query.
• Check the visibility of any additional coverage had been requested by any key client in accordance with the insurance law as well as operational system capabilities and propose the needful enhancement for the operational system if required.
• Meeting with new providers (Hospitals, Policlinics...) to include them into our network and negotiate the discount on their tariff.
• Finalize the annual reconciliation with providers in order to get additional discount based on the business volume.
• Daily report to the superior on the department performance.
• Monthly report to the board member on the overall performance including claims volume, claimed amount, net payable amount...
• Negotiate the discount rate on the tariff of new providers and finalize the annual reconciliation with existing providers which reduce significantly the LR.
• Negotiate the high estimated cases with providers in order to get additional discount.
• Introduce new business concept with providers to reduce the expenses.
• Monitor the hospitalization cases in top providers at Riyadh and finalize some of it on package bases to reduce the claimed amount.
• Medical advice to operation department on claims with huge claimed amount to decide whether to approve or decline the claim.
• Meet key clients (SABIC, AlRajhi...)to answer any coverage or customer satisfaction related issu
• OPD Clinic - Al Wattan Clinic.
• Evaluation of Credit Invoices before the submission to Insurance Companies.
• Reconciliation for the denied claims with Insurance Companies.
• Formulate strategies in the development of all departments reported directly to me.
• Set P & P, KPIs for all departments of the division and ensure it is executed as planned.
• Direct and manage the 7 departments under direct responsibility (Medical services, Food Control, Slaughter House, City Cleaning and Garbage Recycling, Environment, Deads and Graveyard, Chemical Insects Drugs)
• Introduce the computerized system to the day to day process of the division.
• Introduce one window option in order to facilitate the process in licensing for food industry facilities.
• Rolled out the budget of the division.
• Review and monitor the performance of all employees and control any deviation if happened.
• Propose a project for recycling factory in Aleppo and set up the standard for application.
• Direct and manage the two sections under direct responsibility (Clinics, Fitness Certificates).
• Formulate the routine medical screening for the labours of food industry.
• Set the budget, KPIs and P & P of the department.
• Enhance the medical services for Aleppo Municipality's Employees and their dependents.
• Establish multi-specialties clinics (OBS-GYN, Pediatrics, Internal Medicine, Pharmacy, Lab & X-Ray) to serve the employees and their families.
• Establish a network of hospitals, polyclinics and pharmacies to serve all Aleppo Municipality's employees.
• Verification of reimbursement claims for medical services availed out of network.