Insurance director
Royal comission hospital
Total years of experience :27 years, 4 Months
Director of Medical Insurance & Business Development
• Manage Business Development Department.
• Manage Preauthorization and Claims departments.
• Manage Costing and Pricing Department.
• Manage Case Management team and utilization review.
• Manage ICD-10 Coding Department.
• Manage insurance contracts.
• Manage Clinical Pathways Department.
• Manage e-insurance system
• Contribute to identifying the organization’s vision, mission and corporate strategy.
Director / Insurance & Business Development.
• Manage Business Development Department.
• Manage Hospital Excellence team.
• Manage Costing and Pricing Department.
• Manage ICD-10 Coding Department.
• Manager Marketing and social Media
• Manage Case Management team and utilization review.
• Manage Preauthorization and Claims departments.
• Manage insurance contracts.
• Manage Clinical Pathways Department.
• Manage e-Insurance system.
• Manage preauthorization and claims departments.
• Manage Fraud and Abuse Department.
• Manage clinical pathway department.
• Manage Business Development Department.
• Manage case management team.
• Manage Business Development.
• Manage medical Network.
• Contribute to identifying the organization’s vision, mission and corporate strategy
• Contribute to developing the organization’s internal and external brands and market positioning Consolidate and review the business and manpower plans and budgets, and forward to the direct line manager for further approval
• Allocate and control the operational budget, approve significant decisions relating to expenditure
• Ensure the compliance of the division with Governance, Risk Management.
• Monitor staff achievements, perform periodic performance appraisals, and provide guidance or coaching to direct reports
• Review periodic performance reports for medical department.
• Collaborate with COO and top management to align plans and strategies for support, production and sales functions.
• Advise and approve the pricing of exceptional risks, in line with the corporate underwriting policy and the risk appetite expressed by the Board.
• Present and participate in Board and Management committees relating to risk, reporting and changes in the product portfolio
• Make quarterly review of business units’ performance and discuss it in Business Management Committee.
• Manage and set up guidelines and strategic planning for Medical Insurance & Business Operations departments.
• Manage Utilization & Clinical review Dept.
• Manage Insurance contracts for national and global insurance companies.
• Manage, motivate and lead the pre-authorization and claims depts., within defined policy guidelines, compatible with high quality medical standards and are cost effective.
• Manage pricing and cost methodologies to ensure appropriate resource utilization and cost effective, optimum patient care.
• Manage ICD-10 Coding and Costing Implementations.
• Manage Claims Processing, auditing & Customer care dept.
• Manage clinical pathways dept.and e-healthcare system(HMIS)
• Manage communications with CCHI (Council of Cooperative Health Insurance).
• Participate in continuous quality improvement through interdisciplinary team measurement; assessment and improvement of patient care delivery processes
• Manage Information Analysis and development of Special Projects.
• Implement and maintain a risk management process in business operations department.
• Responsible for Setting Up The Medical Department Strategy & Objectives
• Responsible for the Following Operations: Production, Underwriting, Claims, Provider Network, and Computer System.
• Responsible for Medical Claims Auditing.
• Responsible for Medical Pre-Approval for in and outpatient treatment.
• Responsible for Medical Re-Insurance with Major reinsurance co (Munich-re, Zurich- re, Allianez)
• Responsible for Medical Underwriting.
• Responsible for Pre-admission Authorization.
• Responsible for Medical Claims Auditing
The chartered Insurance Institute Associate UK
American Health Insurance Associate (HIA) USA
Volgograd Medical Academy Russia