Ramy Fayek Shehata رزق

Insurance & Claims Advisor
Client Advisory & Risk Assessment: Provide tailored insurance solutions to clients based on their business nature, operational risks, and industry requirements.
 Policy Management & Renewals: Oversee policy renewals, ensuring seamless continuation of coverage while optimizing terms and conditions.
Policy Endorsements & Updates: Process policy modifications and endorsements in alignment with evolving client needs and regulatory requirements.
Claims Handling & Support: Assist clients in claimable events by closely monitoring cases, guiding them through the process, and ensuring timely submission of all required documents.
Claims Documentation & Submission: Review and verify claim documents for accuracy and compliance before submitting them to the claims department.
Broker & Partner Relations: Maintain strong communication with local and regional broker offices to develop partnerships and expand the company’s client base.
Business Development: Identify and establish new business opportunities by building relationships with potential clients and exploring emerging market

Global-Med Group Insurance Unit Head
5/2022 till Present. Final claims audit and verify the statement of accounts and covers letter (submission & resubmission). Scheduling claims submission with the insurance companies. Receiving payments letters form the insurance company. Studying the initial & final rejections claims from the insurance companies “If any” Preparing the reconciliation for the resubmission process. Well negotiate with the insurance companies regarding the rejected claims. Final Monthly reconciliation of each company upon the final payment details. Prepare monthly analysis for approved and rejection amounts as doctor /department wise. Provide finance department with the required data “insurance company credits amounts and payments details “. Follow up with the receivables team for the payment collection from insurance companies. Direct contacting with the physicians to explain and update with insurance guidelines and policy exclusion to avoid any rejection amounts.  Support in new medical services costing. Contacting insurance companies to implement new physicians and new medical services. Studying insurance market prices comparing with our price list.  Follow up with human resources and licensing departments to issue malpractice and liability coverage.  Follow up with insurance team and work to improve the performance for each member upon the weakness points.  Prepare any required reports upon the CFO/Management request.Insurance Supervisor1/2021 till 4/2022. Supervision on Receiving claims on daily basis. Follow up with technical errors till the correction by contacting the concerned departments.
 Claims audit “Medical / technical “before the submission process. Preparing the statement of accounts and covers letter for the submission process  Submission processing upon company deadline.B Follow up resubmissions processing till handed over to concerned physicians. Receiving resubmission claims from departments to verify the doctor’s justification.  Coordinate with other providers for inpatient /Day cases admission &insurance approvals” Visiting Doctors “ Train new join staff. Supporting to solve and answer patients complains / inquiry which is related to the insurance department. Coordinate and update the doctors with the insurance company’s guidelines to avoid anyunnecessary rejection.

As a medical insurance specialist, my main duty is
 Processing insurance claims and assuring that an insurance company reimburses the medical practice for all services  work directly with patients, reviewing their accounts and helping them find solutions, whether it be through Assist patients in obtaining authorization from their insurance companies for specific procedures and Review the insurance contracts and know their terms and identify the excluded services. Identify the patient's share and the deductible amount according to the patient contract. Knowledge of a broad base of medical terminology and how to link the required services with medical Quickly identify the conditions that are out of the coverage and according to the terms/conditions. Communicate with insurance companies professionally to ensure that the better service is provided to the Continuously continue with the insurance companies to get the latest updates for the current and new Extensive experience in the approvals of surgical operations, whether for the doctor of the hospital or a visiting doctor (take into considerati consumables according to surgical package/ surgical Assisting directly in submitting claims to insurance companies on time as agreed

Customer Service &Insurance Coordinator
1. Customer Service:
 Greet patients and register patients according to established
Professional Experience
Senior Insurance specialist As a medical insurance specialist, my main duty is: Processing insurance claims and assuring that an insurance company reimburses the medical practice for all work directly with patients, reviewing their accounts and helping them find solutions, whether it be through insurance Assist patients in obtaining authorization from their insurance companies for specific procedures and treatment. Review the insurance contracts and know their terms and identify the excluded services. Identify the patient's share and the deductible amount contract. Knowledge of a broad base of medical terminology and how services with medical diagnosis. Quickly identify the conditions that are out of the coverage terms/conditions. Communicate with insurance companies professionally to ensure that the better service is provided to the patient. Continuously continue with the insurance companies to get the latest updates for the current and new contracts. Extensive experience in the approvals of surgical operations, whether for the doctor of the hospital or a visiting doctor (take into consideration the doctor fees and medical consumables according to surgical package/ surgical code). Assisting directly in submitting claims to insurance agreed Alia international hospital Customer Service &Insurance Coordinator Service: Greet patients and register patients according to established insurance company reimburses the medical practice for all work directly with patients, reviewing their accounts and insurance treatment. Review the insurance contracts and know their terms and Identify the patient's share and the deductible amount Knowledge of a broad base of medical terminology and how Quickly identify the conditions that are out of the coverage Communicate with insurance companies professionally to Continuously continue with the insurance companies to get operations, whether for the doctor of the hospital or a visiting on the doctor fees and medical code). Greet patients and register patients according to established protocols
 Assist patients to complete all necessary forms and documentation including medical  Ensure patient information is accurate including billing information -Inform patients of medical office procedures and policy -Maintain and manage patient  Move patients through appointments a  Answer incoming calls and deal with  Transfer calls as required  Schedule patient appointments  Collect co-pays and payments  Report statistics as required  Schedule hospital admissions, tests, scans and outside appointments.
2. Insurance Coordinator:
 Coordinate and liaise with insurance network representatives with regards to approval, requests, benefits, and other insurance concerns.  Ensuring coverage of claims, guiding staff for correct use age of claim forms, approval papers  Coordinating with insurance companies for obtaining info on new policies and their coverage  Explaining coverage of medical benefits to patients when  Collecting and verifying all daily insurance claim form for each patient, including surgery claims then submitting daily t Accounts with report.  Networking with insurance companies to obtain accreditation as a  Liaise with patients regarding their eligibility and  Train the staff my knowledge in insurance policies, coverage and codes including (ICD_9, ICD_10)  Keeping track and maintaining properly documents all insurance payments of each patient on file and any insurance related issues.