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Yasser Mohammad Almaslamani, Medical Claim Evaluator

Yasser Mohammad Almaslamani

Medical Claim Evaluator·Saudi Enaya for Cooperative insurance

Saudi Arabia

Bachelor's degree, pharmacy

Work experience

Total years of experience: 20 years, 2 months

Medical Claim Evaluator

January 2014 - Present

Saudi Enaya for Cooperative insurance

Jeddah, Saudi Arabia

January 2014 - Present

1-ICD 10 Coding and proper diagnosis detection according to
the clinical details mentioned in each claim

2-Reimbursment claims evaluation and strict auditing of the associated documents submitted with each claim
3-Capturing of the fraud and abusing cases among clients and preparing weekly reports of these cases
4-Effective communication with various departments, network, underwriting and C.C.C

Company industry:
Insurance & TPA
Job role:
Other

Medical Claim Auditor/Adjuster

June 2009 - August 2011

WAFA Insurance Company

Riyadh, Saudi Arabia

June 2009 - August 2011

1.reimbursmen claims auditing
2.assistance in the policy issuing
3.coordinating with Globe Med Saudi (TPA) in order to achieve optimum services for WAFA clients

Company industry:
Insurance & TPA
Job role:
Other

Network /Medical mapping Officer

May 2007 - May 2009

GMS

Riyadh, Saudi Arabia

May 2007 - May 2009

1.Medical approval officer
2.chronic medications preparing and monthly automatic dispensing
3.medical services mapping
4. MES managing and continuous clinical updating

Company industry:
Insurance & TPA
Job role:
Other

Product Specialist

September 2003 - January 2007

medical equipments

Riyadh, Saudi Arabia

September 2003 - January 2007

Datex Omeda, part of GE Corporation

1-Provide various explanatory materials related to ICU machines like ventilators and vital signs monitors
2-Holding of many in-hospital sessions concerning these medical equipments and give full training for the whole hospital staff who are going to work on them

Company industry:
Pharmaceutical Manufacturing
Job role:
Sales

Education

Jordan University of Science and Technology

June 2003

June 2003

Bachelor's degree, pharmacy

Jordan

GPA (percentage): 78.3%

GPA (percentage): 78.3%

Modules included: Physical Pharmacy pharmaceuticals pharmacology toxicology Pathophysiology Analycal Chemistry Phytochemistry Clinical Pharmacy Medicinal chemistry

Skills

Soft Skills
Expert
Soft Skills
Expert
Science
Expert
Science
Expert
Preparation
Expert
Preparation
Expert
Administration
Expert
Administration
Expert
Insurance
Expert
Insurance
Expert
Soft Skills
Expert
Soft Skills
Expert
Science
Expert
Science
Expert
Preparation
Expert
Preparation
Expert
Administration
Expert
Administration
Expert
Insurance
Expert
Insurance
Expert

Languages

Arabic
Expert
English
Expert
Italian
Intermediate

Memberships

CII

cii member

October 2014

Training and Certifications

Certifications
CII Cert (health and protection)-employee benefits
Dec 2015
IFCE
Jun 2010
english conversarion course
Jun 2003

Hobbies

  • sport
  • reading