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gader alsalman, CLAIMS MANAGER.

gader alsalman

CLAIMS MANAGER.·TOTAL CARE SAUDI THIRD PARTY ADMINISTRATORS.

Saudi Arabia

Master's degree, Administration And Business Administration

Work experience

Total years of experience: 8 years, 6 months

CLAIMS MANAGER.

January 2023 - Present

TOTAL CARE SAUDI THIRD PARTY ADMINISTRATORS.

Khobar, Saudi Arabia

January 2023 - Present

• Responsible for establishing and verifying 100% adherence to
the insurance authority rules and regulatory guidelines.
• Communicating and developing strong and long-term
clients/patients relationship with insurance companies and
the medical healthcare providers on the other hand.
• Effectively negotiating for reconciliation and communicating
in order to resolve issues and supporting an efficient
cooperation with insurance companies.
• Managing more than 100+ employees. And utilizing strong
leadership skills and promoting effective and efficient
teamwork, supervising, supporting, and guiding the claims
team through the whole process.
• Supervising/handling and auditing all procedures related to
medical claims processing, reimbursement, data
management and generating the useful and needed reports
for the insurance companies, healthcare providers and the
higher management.
• Responsible for developing and updating policies and
procedures.
• Establishing a strategic plan based on the mission, vision, and
objectives of the company.
• Providing training and guidelines for employees.
• Adhering and ensuring the teams adherence to all policies
and procedures of TCS, including its code of
conduct/ethics, client service procedures and handling any
conflict of interest as per the company policy. Anti-Fraud Insurance Section Cybersecurity practices Combating money laundering
• Orchestrating and leading a dynamic team of 10+
employees, fostering a collaborative environment to
streamline operations and enhance efficiency in managing
international claims.
• Facilitating seamless communication channels between the
company, Healthcare providers, MSH international and the
Ministry of Health (MOH), in order to ensure a cohesive and
synchronized approach to handle all national and
international medical claims.
• Processing and reviewing medical claims received from
health care providers in UK, EU and USA.
• Implementing a rigorous process to investigate potentially
fraudulent claims.
• Monitoring and following closely the entire life cycle of UK, EU
and USA claims, maintaining a keen eye on progress.
• Creating weekly comprehensive reports and upon request
for management review, contributing to informed decision
making.
• Establishing effective communication channels with patients
and their families by providing support and information
regarding treatment status, fostering positive relationships.
• Developing and updating policies and procedures upon
regulations.

Company industry:
Insurance & TPA

MOH – B2G INTERLOCUTOR.

October 2019 - January 2023

TOTAL CARE SAU DI TH I RD PARTY ADMI NISTRATORS

Khobar, Saudi Arabia

October 2019 - January 2023

Company industry:
Insurance & TPA

Graduate Teaching Assistant

November 2019 - May 2020

Imam Abdulrahman Bin Faisal University

Dammam, Saudi Arabia

November 2019 - May 2020

Company industry:
Laboratory & Quality Control
Job role:
Teaching and Academics

LABORATORY TEACHING ASSISTANT IMAM

January 2018 - October 2019

ABDU LRAHMAN BI N FAISAL U NIVERSITY

Dammam, Saudi Arabia

January 2018 - October 2019

• Instructing 225+ students across multiple science subjects in
laboratory settings.
• Designing and implementing, engaging laboratory
experiments, workshops, and teaching materials in
collaboration with facility members to enhance student
understanding and practical skills.
• Demonstrating innovative leadership by supervising and
guiding students in the proper usage of laboratory
equipment to ensure a safe and conductive learning
environment.
• Actively engaged with students by offering support and
clarification and facilitating an inclusive and conducive
learning atmosphere.
• Implementing specialized instruction on quality assurance,
safety procedures, and panic response in order to ensure
that students are well-equipped with the knowledge and skills
necessary for responsible laboratory practices.
• Adapted to the challenges of the COVID era by successfully
teaching the subject online. Utilized video demonstrations to
effectively convey laboratory experiments, ensuring a
seamless transition to remote learning during the pandemic.

Company industry:
Laboratory & Quality Control

Education

FAISAL UNIVERSITY

January 2026

January 2026

Master's degree, Administration And Business Administration

Saudi Arabia

University of Central Oklahom

May 2018

May 2018

Bachelor's degree, Forensic Science-Molecular Biology

United States

University of Central Oklahom

May 2018

May 2018

Bachelor's degree, Biomedical Sciences

United States

GPA (point): 3.47 out of 4

GPA (point): 3.47 out of 4

Education

University of Central Oklahom

May 2018

May 2018

Bachelor's degree, Biology

United States

GPA (point): 3.47 out of 4

GPA (point): 3.47 out of 4

Education

Skills

Forensic Analysis
Expert
Forensic Analysis
Expert
Genetics
Expert
Genetics
Expert
PCR
Expert
PCR
Expert
Laboratory Medicine
Expert
Laboratory Medicine
Expert
Lab Testing
Expert
Lab Testing
Expert
BUSINESS TO BUSINESS
Intermediate
BUSINESS TO BUSINESS
Intermediate
ADMINISTRATIVE SUPPORT
Intermediate
ADMINISTRATIVE SUPPORT
Intermediate
MANAGEMENT
Intermediate
MANAGEMENT
Intermediate
FORENSIC SCIENCES
Intermediate
FORENSIC SCIENCES
Intermediate
BIOMEDICAL SCIENCES
Intermediate
BIOMEDICAL SCIENCES
Intermediate
BIOLOGY
Intermediate
BIOLOGY
Intermediate
CHEMISTRY
Intermediate
CHEMISTRY
Intermediate
OCCUPATIONAL SAFETY AND HEALTH
Intermediate
OCCUPATIONAL SAFETY AND HEALTH
Intermediate
CARDIOPULMONARY RESUSCITATION CPR
Intermediate
CARDIOPULMONARY RESUSCITATION CPR
Intermediate
ARABIC
Expert
ARABIC
Expert
CPR CERTIFIED
Expert
CPR CERTIFIED
Expert
ENGLISH
Expert
ENGLISH
Expert
MICROSOFT OFFICE
Expert
MICROSOFT OFFICE
Expert
MICROSOFT POWERPOINT
Expert
MICROSOFT POWERPOINT
Expert
PC
Expert
PC
Expert
PCR
Expert
PCR
Expert
SAFETY
Expert
SAFETY
Expert
SCIENTIFIC
Expert
SCIENTIFIC
Expert

Languages

Arabic

Native Speaker

English

Expert

Spanish

Beginner