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Sherif Younis, Process medical manager -preauthorisation-Health insurance

Sherif Younis

Process medical manager -preauthorisation-Health insurance·Bupa Arabia

Saudi Arabia

Doctorate, Membership of royal college of general practioners

Work experience

Total years of experience: 23 years, 3 months

Process medical manager -preauthorisation-Health insurance

June 2011 - Present

Bupa Arabia

Jeddah, Saudi Arabia

June 2011 - Present

Leading medical team in achieving their deliverables with high quality and defined policy with customer satisfaction
•Sharing in implementing guidelines for preauth in Bronchial asthma-FUO-Neonatal admission.
•Continuous CME lectures to Bupa Arabia staff.
•Issuing a medical newsletter on monthly basis to be distributed amongst Bupa Arabia
•Fighting Hospital and member’s fraud, antiselection and undeclared condition.

Company industry:
Insurance & TPA
Job role:
Medical, Healthcare, and Nursing

Senior medical officer

August 2008 - June 2011

Bupa Arabia

Jeddah, Saudi Arabia

August 2008 - June 2011

• Reporting directly to Preauthorization Manager

Responsibilities (as part or Preauthorization Team):
• Adjudicate all requests received from the providers’ regarding BUPA policy & medically.
• Case management.
• Cost control.
• Ensure proper services delivery.
• Fraud detection.
• Anti selection detection.

Company industry:
Insurance & TPA
Job role:
Medical, Healthcare, and Nursing

GP

May 2005 - May 2007

Polyclinic

Jeddah, Saudi Arabia

May 2005 - May 2007

Registered as GP from health spciality

Company industry:
Medical Clinic
Job role:
Medical, Healthcare, and Nursing

Paediatric resident doctor

January 2002 - May 2007

University Hospital

Egypt

January 2002 - May 2007

Risdent Doctor in paediatric dept, University Hospital

Company industry:
Medical Clinic
Job role:
Medical, Healthcare, and Nursing

Education

MRCGP

September 2013

September 2013

Doctorate, Membership of royal college of general practioners

United Kingdom

Faculty of medicine

February 2007

February 2007

Master's degree,

Egypt

I have 1st part master degree in pediatrics

Faculty of Medicine

February 2001

February 2001

Bachelor's degree, Medicine

Egypt

Skills

Insurance Fraud
Expert
Insurance Fraud
Expert
Insurance Claims
Expert
Insurance Claims
Expert
CME
Expert
CME
Expert
Family Medicine
Expert
Family Medicine
Expert
Health Insurance
Expert
Health Insurance
Expert
Up you service course
Expert
Up you service course
Expert
IFCE course
Expert
IFCE course
Expert
Bussiness communication and time managment
Expert
Bussiness communication and time managment
Expert
Excel
Expert
Excel
Expert
Insurance Fraud
Expert
Insurance Fraud
Expert
Insurance Claims
Expert
Insurance Claims
Expert
CME
Expert
CME
Expert
Family Medicine
Expert
Family Medicine
Expert
Health Insurance
Expert
Health Insurance
Expert

Languages

English
Expert

Memberships

Royal college of general practitioners

Family medicine

September 2013

Training and Certifications

Training
Bussiness development
Green belt six sigma
Apr 2013
Bussiness communication and time management
Bupa
Mar 2011
SAMA-Insurance certificate
IFCE
Feb 2010