Insurance Medical
Resume:
CURRICULUM VITAE
SYED SAADULLAH
Mobile: +966-**-****-*** ~ E-Mail: *************@*****.***
Job Assignments – Executive Secretary / Receptionist
SUMMARY
Skill Set
Nearly 24 years’ well experience in Medical Insurance Policy and Claims Department. Worked with Saudi Arabian Cooperative Insurance Co as a Receptionist as well as Executive Secretary work also organization utilized me as per work requirement . Vast exposure in managing all aspects of medical insurance operations and claims of various portfolios (group medical insurance)
Skilled in guiding the accreditation & periodic reviews of the Insurance provider network for continuous improvement and maintenance of the quality service. Actively involved in managing employee saving plan within the policy/procedures including additions/cancellations, partial settlements and proper record keeping. Deft in providing leadership for unit operations. Effective
communicator combined with flexible and detail oriented attitude.
CORE COMPETENCIES
Establishing relationship with decision makers to strategically manage beneficial associations / alliances
Formulating & implementing guidelines, processes, workflow, application forms, etc.
Managing claim procedures involving validity assessment and approvals of high value claims in compliance with regulatory requirements
Overseeing proper management and disbursal of insurance funds in timely manner and ensuring that all the respective accounts are duly reconciled
Assuring the employees receive and enjoy the full benefits of medical coverage and other insurance schemes and to facilitate all the related processes in order to save time and efforts of management
Making sure that all sort of agreements reached with the insurance provider are in line with internal laws of
Kingdom of Saudi Arabia
Enhancing and updating the procedures to ensure excellent delivery of all insurance schemes
Gaining pre-approval for treatment outside territory for elective services like delivery, cold surgeries, etc. outside KSA and tracking the same so that claims will be processed without delays and paid without the undue deductions
Leading customer centric operations & ensuring customer satisfaction by achieving delivery & service quality norms
Attending to clients’ concerns & complaints and undertaking steps for effectively resolving them
Accelerating employees’ strengths and building teams that can conquer any obstacles
Ability to perform well on both independent contributor and team member
ORGANIZATIONAL EXPERIENCE
Started my career in SAICO since 1993 Worked in various departments company utilized me as per my dedication & knowledge in all departments such as in Approval, Accounts, Policy Admin Dept. Medical Claims, Medical Network,. RC Claims . worked in same Organization as Receptionist /Executive Sercretary. Saudi Arabian Cooperative Ins Co. (SAICO) Therefore looking forward to new challenge in any other good Organization.
Role:
Generating new business from clients.
Building and maintaining business relationship with clients
Building excellent customer relationships both face to face and over the phone.
Assisting in account development.
Reconciling any inventory discrepancies.
Resolving and customer issues in a timely and professional manner.
Maintaining accurate administrative, filing and record keeping systems.
Ability to problem solve within established policies and procedures.
Negotiating policy terms and costs with insurance providers.
Preparing reports for insurance underwriters.
Creating detailed proposal documents.
Actively encouraging staff to build customer relationships.
Determine discounts and premiums.
File reports of numbers of insurance quoted.
Ensured all policy requirements are fulfilled.
Monitored insurance claims to ensure settlement.
Listening to client requirements and presenting appropriately to make sales.
Responding to incoming mails and phone queries.
Ensure resolution of processing claims in a time-efficient manner
Follow up on unpaid claims, including denial, exceptions and exclusions
Ask why claims have been denied and provide relevant correlating information
Resubmit denied claims with additional information to prove denial is inappropriate
Provide information to collection for clients regarding delinquent or past due accounts
Post payments to accounts and maintain records
Rendered full support in delivering the Credit & Debit Notes
Managed the death & disability claims processing & payments for Repatriation cases.
Handled the outside KSA cash claims for pre-approval of medical services and review of disputed or reject pre-authorization requests from approval dept.
Reviewed the disputed or rejected cash claims, request and follow up changes to the appointed network
Enhanced and updated the procedures and processes to ensure excellent delivery up to provider/client.
COURSES / CERTIFICATION
IFCE Insurance Certification/ The Institute of Banking KSA qualified in 2013.
Bachelor of Commerce B.Com. from Osmania University AP India in 1992
Type writing Higher qualified from Maharashtra in 1990
IT Skills: Microsoft XP applications (Word, Excel, Office, PowerPoint, Outlook, Access)
AREAS OF EXPERTISE
Productivity enhancement
Negotiations
Team leadership & collaboration
Implementing system processes
Processing/Documentation
Well versed about the total workflow of Medical Claims department.
Managing as received Claims from providers day by day verifying exceeding 60 days delaying in submission or not taking monthly outstanding analysis .
Looking after that data entered perfectly by co-insurance with discounts.
Verifying claims on review stage coverages exclusion uncovered services to be rejecting over all rejections not payable details for wording to the providers.
Network all region maintain payments of percentages of total per quarters loss ratio with IBNR.
Verifying eligibility Checking approvals & second opinion provider appointed.
Verifying Outpatient & Inpatient Claims total claims & amount per monthly basis.
Inpatient cases verifying clear Diagnosis procedures or package deal by provider.
Preparing Reimbursement Claims with Initial stage to finalizing upto payments.
Reimbursement Claims verifying exceeding 90 days, customary cost by network.
Reimbursement Claims verifying Outside territory emergency or non-emergency.
Prepare reconciliation statements for all balance sheet items and revenue items .
Sending Credit Confirmations rejections details to the providers monthly basis.
Preparing Credit Notes as per the payment confirmation to the providers
If any Ineligible claims or deleted member claims preparing Debit notes forwarding to Accounts department .
Monitoring standard identity opportunity for better processing.
Knowledge about the Reimbursement Claims processing.
Other Claims payments rejections, ratio analysis functions for the day-to-day operations of the office, as required
PERSONAL INFORMATION
Date of Birth
Visa Status
Marital Status
05/06/1969
Transferable
Married
Nationality
Languages Known
Driving License
Indian
English, Urdu and Arabic
Valid Saudi License
INTERESTS AND ACTIVITIES
PASSPORT NO. K 8425948 ISSUED : 15/09/2012 EXP. 14/09/2022: Iqama Still 14 Months valid
I hereby declare that all the details furnished above are true to the best of my knowledge and belief.
SYED SAADULLAH
RIYADH.
REFEREE
Dr. Khalid Hanoon
Manager, Claim Department
Saudi Arabian Cooperative Ins. Co.
Head Office – Malaz Street, Riyadh
Email: ********@*****.***.**
Contact this candidate