Nehal Abdel-Mawla Ghazala
(*****) - ******** Kuwait-Hawalli,Tunisia St.
ac3d62@r.postjobfree.com https://kw.linkedin.com/in/nehal-ghazala-b945b99
Summary
Talent & Dynamic Insurance Unit Head with 10 years’ experience in the medical insurance claims management, team worker ambitious individual, proven ability to work under pressure, fit with any new team and a fast learning worker committed as well to the quality level.
Professional Experience
YIACO Medical Company Nov 2016 - present
Insurance Unit Head
Prepare, manage and place insurance quotations and coverage required for company’s medical projects on timely basis.
Manage data to appropriately track and report to insurance carriers.
Ensure requests for certificates of insurance and other items are processed on a timely manner.
Review policies for accuracy and coverage. Order policy changes as required providing adequate and necessary coverage for new locations and exposures.
Ensure certificates received from owners are reviewed to ensure their insurance complies with company medical standards and contract requirement.
Constantly improve and update procedures and processes to ensure excellent delivery of all insurance services.
Assist in the annual renewal process for company’s corporate insurance.
Assist in claims management and reporting as required.
Work with costing, subcontracting and accounting with project issues.
Maintain on-going contact with area offices to discuss any new insurance procedures, answer ongoing issues relating to project insurance and help whenever necessary.
In conjunction with medical director, communicate regular and effectively with supervisors and other necessary to manage company’s medical insurance.
Communicate with legal department for both contract reviews and any claims assistance they may require.
Work co-operatively with customers and employees to deliver excellent quality services.
Investigate and resolve related problems in timely manner. Liaises with internal and external contacts to collect relevant information.
Ensure employees are properly trained to recognize and produce service and products in performing their various quality auditing and testing functions.
Support, comply and implement both safety and quality policy and programs as directed by the company or otherwise approved by management.
Gulf Life Insurance Company Jan 2014 – Nov 2016
Senior Claims Auditor
Audits outpatient claims subject to policy terms and conditions, exclusions and limits.
Manages over than 150 policies stock, control and replay on any inquiry regarding such.
Re-Audits the claims after TPA for quality assurance purpose.
Manages the Debit Notes Elite policies documentation and quires.
Negotiates with clients the policy terms and conditions applying customers service standards.
Performs Quarter cyclic meeting with the TPA in order to evaluate the level of service and discussing the means for the development.
Research and investigate risks and profit margin of the business.
Creates quality reports based on the data collected and follow up remedy actions.
Manages clearance letters and discharges summary for the concerned clients, issuing such after the specific audit and review.
Oversee all the archiving electronic system and coordinate between the different parties.
Maintains communication with different providers and TPA company to achieve the highest level of knowledge transfer & cooperation.
Med connect Third Party Administrator May 2009 - Jan 2014
Medical Manager.
Managed all preapprovals and claim cycle in the TPA starting from receiving the batches, medical auditing, utilizing in application, financial auditing, rejection sheets, negations with hospitals and the final rejections as well.
Investigated and explain the internal structure of the organization and the employment arrangements in business organization.
Researched the influence of the environment on the TPA organization, as investigate the relation between the TPA and the market
Developed and evaluated business documentation and appraise the characteristics of effective group communications.
Negotiated with clients the policy terms and conditions in purpose of customer satisfaction.
Directed stuff consisted of 5 data entry and two Doctors.
Taiba hospital Jan 2006- May 2009
Insurance and contracts supervisor.
Executed all in and out preapprovals issued from the hospital to all insurance companies contracted with the hospital.
Reviewed data and diagnosis written by the doctor, completed all requirements needed by the insurance companies to issue such, following up the preapprovals as well.
Managed all rejection claims sheets from all insurance companies contracted with hospital.
Overseen completion of the data and documents as policy conditions.
Created on the hospital Oracle application all the various polices of insurance companies.
Trained concerning staff on differences between policies Business meetings with different insurance companies, discussing the new policies and terms, rejections, contracts and claims cycle as well.
Operated the contracts between hospital and different insurance companies.
Education
Cambridge University
International Business Diploma 2010.
University: Alexandria.
Bachelor of Pharmaceutical Science May 2005.
Additional skills
Computers Skills: MedNex system User, Arch mate System user, Microsoft word and Excel Excellent skills.
Training:
Working in ADAAN pharmacy from 2002 to 2003:
a trainee pharmacist dealing with patient and customers as per needs and medical ethics monthly revision on the pharmacy content and drugs expiry pricing the drugs as per policy and medical terms preparing any drugs prescription as per prescribed by the doctor.
Working in Ragaay pharmacy from 2003 to 2004:
a trainee pharmacist dealing with patient and customers as per needs and medical ethics monthly revision on the pharmacy content and drugs expiry pricing the drugs as per policy and medical terms preparing any drugs prescription as per prescribed by the doctor.