رواد Feghali

As a Senior Arbitration Officer, you play a critical role in managing medical claim disputes between healthcare providers and the TPA. You ensure fair, evidence-based resolution of cases through thorough analysis of clinical documentation, application of medical guidelines, and knowledge of insurance policies and contractual terms.

• Spearheaded complex claims reconciliation initiatives, resolving coding errors and
payment discrepancies across high-volume claim portfolios exceeding 10, 000
monthly transactions
• Executed comprehensive provider submission reconciliation against policyholder
records, achieving 100% contract compliance and regulatory adherence
• Designed and implemented advanced fraud detection strategies, resulting in
improved claim accuracy and reduced financial losses by 15%
• Developed innovative audit methodologies that enhanced non-compliance
detection rates and streamlined investigation processes
• Collaborated with Quality Assurance teams to establish enterprise-wide best
practices, leading to department-wide performance improvements
• Delivered strategic audit reports and actionable recommendations to C-level
executives, driving organizational policy changes
• Maintained continuous compliance with evolving healthcare regulations including
HIPAA, ACA, and local Lebanese healthcare standards

• Managed end-to-end reimbursement operations for 50, 000+ annual claims,
ensuring optimal processing accuracy and regulatory compliance
• Led and mentored a team of 5 processing officers, providing comprehensive
training, performance coaching, and career development guidance
• Architected and implemented comprehensive Standard Operating Procedures
(SOPs) that eliminated processing bottlenecks and standardized quality metrics
• Cultivated strategic relationships with clients, healthcare providers, and insurance
partners to resolve complex claim issues and enhance service delivery
• Monitored and analyzed key performance indicators, generating data-driven
insights that informed strategic decision-making and process optimization

• Delivered comprehensive bedside care in high-acuity emergencies, cardiac, and
surgical units across multiple healthcare facilities
• Provided patient and family education on complex medical procedures, post
operative care protocols, and discharge planning
• Collaborated with multidisciplinary medical teams to manage critical cases,
emergency situations, and post-surgical recoveries
• Developed expertise in clinical documentation and demonstrated exceptional
multi-tasking abilities in high-pressure environments
• Actively participated in quality improvement initiatives and maintained strict
compliance with clinical standards and safety protocols
• Mentored junior nursing staff and contributed to comprehensive staff development
programs
• Coordinated patient care transitions and discharge planning in fast-paced clinical
settings