Executive, Operations
Asyad Qatar
Total years of experience :22 years, 8 Months
Overseeing below activities:
- Customer care
- Transportation
- Administration
Team lead, Health Claims Operations - Provider claims and Reimbursement claims
Duties and Responsibilities:
- Receiving direct billing and Reimbursement claims
- Auditing and processing the claims
- Closing and Settlement
- Ensure timely dispatching of cheques and rejection statements
- Provider Reconciliation, negotiation and final settlements
- Monitoring the daily work flow
- Planning the claims operations
- Analyzing the claims reports and provider trends
- Statistical analysis
- Giving inputs to contracts admin team for price list negotiation
- Technical and Gap analysis for system enhancements
- Preparing claims report for Regulators and Higher Management
Duties and responsibilities included:
Issuing medical insurance policies
- Receiving the required documents and validation
- Members enrollment
- Updating the policy terms and conditions on system
- Raising the payment voucher to the clients
- Linking to network providers as per classes and conditions
- Policy wording
- Medical cards printing
- Delivery of medical cards and policy documents
Duties and responsibilities included:
- Briefing the medical insurance policies with HIS system (summarizing medical insurance policy benefits and exclusions according to the agreed terms & conditions between the Medgulf & Policy holder)
- Sending these Briefings to Health care Providers in KSA, Bahrain & Jordan using Active Fax system according to the classification of providers & classes of the insured members
- Updating all the data in system regarding policy amendments, suspension, reactivation & cancellation of policies
- Classification of providers in active fax system according to contractual agreements
- Proper communication to the providers to ensure proper medical care to the insured members
- Updating the Policy briefings to all assigned providers after amendments of the policies
- Out patient physical therapy services
- Home care programs
Duties and responsibilities included
-Preparing Quotations and Tenders
-Supporting Sales engineers
-Placing the Purchase order to manufacturing & marketing companies
-Ensuring the timely delivery of Medical equipments and Reagents
Attained good experience & knowledge within this period
Four years full time course and six months internship training completed