Senior Insurance Administrator
ABV ROCK GROUP LIMITED
Total years of experience :10 years, 5 Months
1. To ensure that the ABV Rock Group Medical Insurance Policy is applicable in the clinics and hospitals, I can monitor the network of providers that are covered by the policy and cross-check it with the ones that are available in the clinics and hospitals where ABV employees seek treatment.
2. To issue Medical Insurance for ABV employees and their dependents as per KPI, as an AI assistant, I can create a database of all ABV employees and their dependents that are eligible for medical insurance and also provide information on the different medical insurance packages available to them as per their KPI.
3. To cancel the medical insurance for terminated employees and their dependents, I can set up a system that automatically updates the database and cancels the insurance policy once an employee is terminated.
4. To upload employee data in CCHI (Council of Cooperative Health Insurance), I can create a system that automatically transfers employee data to CCHI and ensures that it is accurately entered into their database.
5. To communicate with insurance companies in order to get pre-approval for all employees and their dependents for treatment outside network providers or outside KSA, I can set up a system that streamlines the approval process and tracks pre-approvals in real-time.
6. To handle employees’ medical cash claims and follow up on reimbursements by insurance companies, I can create a database to keep track of claims, follow-up with insurance providers, and ensure timely payments.
7. To receive employees’ medical insurance approval complaints and manage to solve it, the complaints will then be routed to relevant personnel for prompt resolution.
8. To escalate non-solved medical issues to management, I can automatically generate reports for management that highlight any pending or ongoing medical issues that need attention or resolution.1. To ensure that the ABV Rock Group Medical Insurance Policy is applicable in the clinics and hospitals, I can monitor the network of providers that are covered by the policy and cross-check it with the ones that are available in the clinics and hospitals where ABV employees seek treatment. 2. To issue Medical Insurance for ABV employees and their dependents as per KPI, as an AI assistant, I can create a database of all ABV employees and their dependents that are eligible for medical insurance and also provide information on the different medical insurance packages available to them as per their KPI. 3. To cancel the medical insurance for terminated employees and their dependents, I can set up a system that automatically updates the database and cancels the insurance policy once an employee is terminated. 4. To upload employee data in CCHI (Council of Cooperative Health Insurance), I can create a system that automatically transfers employee data to CCHI and ensures that it is accurately entered into their database. 5. To communicate with insurance companies in order to get pre-approval for all employees and their dependents for treatment outside network providers or outside KSA, I can set up a system that streamlines the approval process and tracks pre-approvals in real-time. 6. To handle employees’ medical cash claims and follow up on reimbursements by insurance companies, I can create a database to keep track of claims, follow-up with insurance providers, and ensure timely payments. 7. To receive employees’ medical insurance approval complaints and manage to solve it, the complaints will then be routed to relevant personnel for prompt resolution. 8. To escalate non-solved medical issues to management, I can automatically generate reports for management that highlight any pending or ongoing medical issues that need attention or resolution.
Skills: Problem Solving · Microsoft Excel · Microsoft Word · Teamwork · Health Insurance · General Insurance
Handling General and Medical Insurance related administrative work activities for 10, 000+ members.
Worked in the Sales Department mainly in the General and Medical Sales activities.
Preparing prospects and making cold calls.
Preparing weekly and monthly sales reports.
Risk Management
Sikkim Manipal University
Chartered Insurance Institute, London
Awarded by the Chartered Insurance Institute, London.
Chartered Insurance Institute, London (October 2011) • Diploma in Insurance Principles & Practice
Cambridge International College, UK