Medical Group Claims Officer
MetLife Alico
Total des années d'expérience :11 years, 5 Mois
June 2006 - May 2012
MetLife Alico
Medical Group Claims Officer
Duties:-
• Assume primary responsibility for structuring and executing operational and strategic initiatives developing work plans, leading analyses, and developing final recommendations
• Coding and processing claim forms
• Reviewing Claims by assuring the services done are justified by the given diagnosis.
• Correcting and completing forms as needed
• Accessing information and translating data into acceptable claims processing requirements
• Preparing rejected claims for re-submission
• Processing claims in accordance with contracts and policies
• Following up on suspended claims
• Assisting, identifying, researching and resolving coordination of benefits
• General inquiry issues
• Preparing formal history reviews
July 2003 - May 2006
New Balsam Pharmacy - UAE- Dubai
Pharmacist in Charge
Duties: -
• Place all the orders from Drug Stores.
• Follow up with the orders with the stores and make sure the deliver the medicine as ordered.
• Make sure that all kinds of medicine are always available on the shelves.
• Monitor the expiry date of each medicine and make sure to return all those about to expire to the suppliers.
• Make sure to give to the patient the exact medicine, as per the prescription and to offer a substitute if the brand prescribed is not available.
• Make all the data entry of all suppliers' invoices and daily sales on the computer system. Also, do the cash reconciliation daily.
• Organize the monthly payments for suppliers.
• Make sure that the pharmacy is always clean and tidy.
Aug. 1998 - January 2001
Qusibaty Pharmacy - Amman
Pharmacist in Charge
Duties: -
• Place all the orders from Drug Stores.
• Follow up with the orders with the stores and make sure the deliver the medicine as ordered.
• Make sure that all kinds of medicine are always available on the shelves.
• Monitor the expiry date of each medicine and make sure to return all those about to expire to the suppliers.
• Make sure to give to the patient the exact medicine, as per the prescription and to offer a substitute if the brand prescribed is not available.
• Make all the data entry of all suppliers' invoices and daily sales on the computer system. Also, do the cash reconciliation daily.
• Organize the monthly payments for suppliers.
• Make sure that the pharmacy is always clean and tidy.
Have a respectful job, where I can have self-satisfaction and a potential to develop a career in my field of specialty, with a decent income. September 1993 - June 1998 University of Applied Science University Amman, Jordan++ Graduate on June 1998. B.Sc. in Pharmacy
September 1990 - June 1992 Clifton High School New Jersey - USA