Physician, Medical Insurance Claims Expert

Dr. Mohammed Amin Abdul Malek

Dukhan, Qatar ********@*****.*** (974-***-***** linkedin.com/in/dr-mohammedamin-malek

Strategic healthcare insurance and operations leader with 25+ years of international experience in improving healthcare delivery, medical insurance operations, and clinical governance across Qatar, India, and Saudi Arabia.

Recognized for managing revenue cycle, insurance risk, and regulatory excellence with a focus on transforming healthcare delivery and improving patient-centered outcomes. Expert in aligning operations with financial stewardship, quality accreditation, and long-term strategic growth.

-Proven background in directing healthcare operations and managing multimillion-dollar budgets, strategic workforce planning, and provider contracts to elevate patient satisfaction and reduce costs.

-Extensive background in advancing medical insurance governance by reducing claim rejections, implementing ICD-10-AM based charge master systems, and accelerating claims cycle time by 29%.

-Proficient at maintaining provider networks by negotiating cost packages, designing integrated care pathways, and representing organizations during Ombudsman reviews and external audits.

-Demonstrated success in building and mentoring high-performing clinical and insurance teams, customizing EMR/claims systems, and embedding operational excellence across complex healthcare ecosystems.

CORE PROFICIENCIES

Healthcare Operations Leadership Medical Insurance Management Revenue Cycle Optimization Provider Contract Negotiations

Quality & Accreditation (ISO, AC) Regulatory Compliance & Audits Strategic Planning & Governance Budgeting & Cost Control

EMR & Claims System Integration Risk Management & Compliance Control Patient Satisfaction & Experience Management

Occupational Health & Safety Programs Emergency & Crisis Response Leadership Workforce Planning & Resource Optimization

PROFESSIONAL EXPERIENCE

QATARENERGY Dukhan, Qatar August 2005 to Present

Lead Primary Care Physician (Jan 2021 to Present) Medical Officer (August 2005 to Dec 2020)

Oversee primary care operations, quality governance, and occupational health for QatarEnergy’s Dukhan Healthcare Centre. Manage all aspects of strategic planning, clinical governance, budgeting, insurance processes, and team leadership.

Increased patient satisfaction to 96% (2022 to 2024) by leading the implementation of the CFCC/People Centered Care model and optimizing customer feedback resolution processes.

Maintained Diamond Accreditation from Accreditation Canada across three consecutive cycles by designing and executing robust quality and governance initiatives.

Reduced overtime costs by 42% in four years through deploying strategic workforce planning and resource optimization initiatives.

Reduced insurance claim rejections by providing training on medical insurance claims, coding accuracy, and process compliance.

Standardized revenue cycle management function by implementing a Charge Master system using ICD-10-AM codes.

Received Certificate of Appreciation from Qatar Petroleum Medical Services for developing diabetes guidelines and supporting hospital management programs.

Recognized by senior leadership and appointed as a Member of the Ministry of Public Health (Qatar) National Clinical Guidelines Committee for Low Back and Neck Pain in Adults.

Maintained world-class healthcare delivery during a global sporting event by serving as an integral member of the Medical Team for FIFA World Cup 2022.

PARAMOUNT HEALTH SERVICES PVT. LTD. Mumbai, India Nov 2004 to July 2005

Senior Manager, Medical Management

Headed medical management operations for India’s leading TPAs serving 2.5M lives across 27 branch offices, including claims management, provider negotiations, compliance, and team leadership.

Improved claims cycle time by 29% by collaborating with claims and finance teams and streamlining complex payment processes.

Reduced hospital length of stay and optimized cost efficiency by designing Integrated Care Pathway (ICP)–based provider packages.

Mitigated legal and compliance risks by managing dispute responses, representing the company before Ombudsman and Consumer Courts, and serving as TPA representative during external audits.

Planned and established an effective 15-physician medical scrutiny department to boost accuracy and efficiency in claims review.

Standardized quality assurance by conducting medical audits across branch offices and ensuring adherence to pertinent standards.

MILLAH HEALTH CARE SERVICES Riyadh, Saudi Arabia Dec 2003 to Sept 2004

Medical Director

Oversaw medical operations, claims management, and clinical services for corporate clients, including claims and pre-authorization processes, provider relations, and medical staff recruitment.

Achieved a 10-minute turnaround time for pre-authorization requests by collaborating with the IT team, optimizing workflows, and improving system support.

Maintained productive provider relations by negotiating claims settlements and creating cost packages with healthcare providers.

Increased client satisfaction by managing customer relations with corporate accounts and ensuring service delivery standards.

Built high-performing medical teams by providing recruitment and leadership oversight for healthcare professionals across clinics.

EARLY CAREER

General Practitioner - Ministry of Health, Directorate General of Health 2002 - 2003

General Physician/Emergency Room Physician - Taif Medical Centre, Riyadh 1995 - 2000

Casualty Medical Officer - P. D. Hinduja National Hospital & Medical Research Centre

House Physician (Cardiology/ICU/ICCU) - Jaslok Hospital & Research Centre

Resident House Physician (General Medicine) - The Bomanjee Dinshaw Petit Parsee General Hospital

EDUCATION

MBBS, Topiwala National Medical College (T.N.M.C.) & B. Y. L. Nair Charitable Hospital, University of Mumbai

CERTIFICATIONS

Six Sigma Green Belt Training ISO 9001:2000 Lead Auditor (IRCA UK) OHSAS 18001:2007 Lead Auditor (IRCA UK)

Signature Leadership Program for Frontline Leaders Certified Course in Aero Medical Retrieval and Transport (CCAT)

Joint Commission International Practicum Management Development Program – Hospital Administration

Finance for Non-Finance Professionals Emotional Intelligence Middle Manager Development Program

Root Cause Failure Analysis Occupational Medicine Course Advanced Life Support (ALS) International Trauma Life Support (ITLS)

PROFESSIONAL ASSOCIATIONS

Maharashtra Medical Council (India) Saudi Council for Health Specialties (Saudi Arabia)

Qatar Council of Healthcare Practitioners – MOPH (QCHP) Healthcare Financial Management Association (HFMA)

Chartered Insurance Institute (CII) American Health Information Management Association (AHIMA)

American College of Healthcare Executives (ACHE) Association of Healthcare Internal Auditors (AHIA)

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