Senior Medical Insurance Physician/ Case Manager
Al-Mouwasat Medical Services
مجموع سنوات الخبرة :12 years, 1 أشهر
Represent the company in various internal and external meetings and promote existing and new programs/policies. In addition, monitoring all aspects of insurance companies, credit issues & the council of co-operative health insurance regulations (CCHI) through follow up of inpatient and outpatient approvals. Moreover, review insurance companies’ contracts through co-ordination with marketing department for better customer service and co-ordination with finance department to ensure proper claims processing. In addition to supervising and scheduling employees’ work assignments in order to ensure smooth work flow and achieve companies’ strategies and objectives
Maintain AMC clients’ satisfaction starting with the pre-sales till the contract renewal by acting as the focal point between the clients and AMC by Communicating and coordinating with AMC departments and clients to facilitate finalizing client’s demands through handling and monitoring intra and interdepartmental communications to resolve any obstacles facing the clients. In addition to conducting regular visits to the clients and provide any recommendations or suggestions to the clients in order to enhance the medical service provided.
Supervise and monitor the process of verification and evaluation of the medical provider claims conducted by the medical processing team according to medical justification, policy and procedure in order to reach optimum handling of payments in addition to medical providers’ satisfaction.
Issue all approvals according to TOB (Table of Benefits) to clarify the clients’ employees’ benefits and to abide to the designed SLAs for issuing approvals and financial authority levels of issued approvals in addition to handling customer inquiries and also approving the sick leaves and the pre-employment check-up received.
Issue all approvals according to TOB (Table of Benefits) of each NBE and clarify the clients’ employees’ benefits and to abide to the designed SLAs for issuing approvals. Also Abide to financial authority levels of issued approvals according to policy and procedures and Handle customer inquiries or complaints and approve the sick leaves and the pre-employment check-up received from the NBE
America's Health Insurance Plans Curriculum (AHIP)
The diploma was for 2 years and its contents included 6 modules in addition to a final project : - Management Module - Human Resources Module - Quality Module - Finance Module - Marketing Module - Information Technology Module After this diploma, I was certified and liscensed by Egyptian Medical Syndicate and American University in Cairo as Healthcare and Hospital Management Specialist and is MBA equivalent in Healthcare industry.
Very good grade