Network officer
Gulf insurance company
مجموع سنوات الخبرة :15 years, 10 أشهر
• Handling a Providers contracts from A to Z
• Maintaining a data related to 130 providers all over the Kuwait.
• Good quality of negotiating whenever required.
• Receiving a price list from providers and study them in structured way mapping the codes by using ICD.
• Providing training sessions for doctors in hospital regarding the policy coverage and exclusions.
• Providing online TPA system training for hospital staff.
• Participating in a meeting related to reconciliation
• Admin for a user data of online TPA link.
Wapmed TPA Services Co. under (Warba Insurance Co. KSCC)
Designation: Supervisor - Claims/Operations
Duration: August 2008 - 2010
Job Profile:
• Oversee the day to day operations in terms of quality of work and turn around time (TAT)
Job Profile
Role & Responsibilities:
• Analyzing strategic work protocol.
• Follow up with Team adhering TAT.
• Producing Quality Services par highest corporate standards.
• Ensuring Customer Satisfaction enhancing business prospects.
• Rapid solving of escalation in quickest possible time frame.
• Coordinate with Insurance Companies and Hospitals for resolving issues related to claims managements.
• Ensure commitments are performed within agreed SLA.
• Liaison with Corporate companies and underwriting offices.
• Provide MIS reports to Corporate and Insurance Companies
• Correspond to the customer queries.
• Maintain claims.
➢ Insufficient Report files (IR)-Reconcile by coordinating with members, resolving settlement of claims that are pending due to insufficient reports.
➢ Case investigation Insurance files (CII files)-claims pending due to lack of adequate information & feedback from the insurance companies.
➢ Not in database files (NIDB)-claims of members that are not yet enrolled for unavailability of policy copies.
Gulf Insurance Co. KSCC
Designation: Network officer - Medical network department specialized for Kuwait petroleum project.
Duration: August 2010 - Till the Date.
Job Profile:
• Handling a Providers contracts from A to Z
• Maintaining a data related to 130 providers all over the Kuwait.
• Good quality of negotiating whenever required.
• Receiving a price list from providers and study them in structured way mapping the codes by using ICD.
• Providing training sessions for doctors in hospital regarding the policy coverage and exclusions.
• Providing online TPA system training for hospital staff.
• Participating in a meeting related to reconciliation
• Admin for a user data of online TPA link.