Policy Administrative Coordinator
Arabian Shield Cooperative Insurance Company
مجموع سنوات الخبرة :17 years, 6 أشهر
'Provide a full range underwriting support and customer service.
' Develops and maintains business unit relationship.
' Process and provides medical insurance card to clients in line with the policy terms & company procedures.
' Responsible for receiving correspondence & medical documents such as reimbursement claims and other documents that supports client requests.
' Responsible to make follow up and coordinate in main office with regards to all the concerns of clients and members. (Reimbursement claims, approval status etc. etc.)
Policy Administrative Coordinator (Almarai Co.) (Sept. 25, 2012 up to present)
Responsibilities:
• Provide a full range underwriting support and customer service.
• Develops and maintains business unit relationship.
• Process and provides medical insurance card to clients in line with the policy terms & company procedures.
• Responsible for receiving correspondence & medical documents such as reimbursement
claims and other documents that supports client requests.
• Responsible to make follow up and coordinate in main office with regards to all the concerns of clients and members. (Reimbursement claims, approval status etc. etc.)
Medical Claims Processor / Claims Processing Supervisor / Medical Claims Accounts
Supervisor / Admin Policy Coordinator (Almarai Company)
Arabian Shield Cooperative Insurance Company
August 13, 2009 up to present
Medical Claims Account Supervisor (Feb. 29 to, 2012 to Sept. 24, 2012)
Responsibilities:
• Responsible is assuring the accuracy of accounts being transferred to the provider.
• Monitor and follow up claims not paid in timely manner.
• Responsible for overseeing the daily cheque and to monitor the accuracy of daily
payment to the provider.
Claims Processing Supervisor (June 29, 2011 to Feb. 28, 2012)
Responsibilities:
• Examines, evaluates, and audit claims for medical, dental, and behavioral health
program.
• Handles complex claims, troubleshooting inaccuracies, performing audits, and researching adverse benefits determination pursuant to federal legislation and
regulation; recommending action on appeals; negotiating letters of agreement and single case agreement with out of network providers and data analysis of aggregated
claims data.
• Responsible for maintaining, upgrading and configuring the automated claims processing
system.
• Review, record & elevate outstanding claims to our Manager.
Medical Claims Processor (August 13, 2009 to June 28, 2011)
Responsibilities:
• Familiarize himself with all company's procedures and operations.
• Performs all duties assigned within the Medical Dept.
• Develops knowledge and experience in the insurance related matters, in general & in
Medical Insurance in particular.
• Responsible for receiving correspondence & medical documents.
• Review, record & elevate outstanding claims to supervisor.
• Process valid claims for settlement in line with policy terms & company procedures.
Claims Assistant
Globe Med Saudi
October 28, 2007 to April 10, 2008
Responsibilities:
• To enter data into computer database and organize and maintains files.
• To scan claims and forward into the Claims Processor for processing.
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Far Eastern University Bachelor of Science in Math Major in Computer Science 2001 - 2005 Granary Co - Educational Institution Secondary Level