Medical Insurance
Resume:
DR KANWAL JAVED
King Fahad Road Olaya
Riyadh, Saudi Arabia
Cell: 009**-*********
Email: ***********@**********.***
Objective
To seek employment in a health or health related organization, whose culture inculcates delegation of responsibility, merit based rewards and opportunities for growth and whereby I can learn and hone my skills further in a manner that will prove beneficial mutually to my employer and my self.
Qualification
CII Certificate course 2011
Passed 2 papers
From CII Institute London
MBBS 2006
From sindh Medical College
1st division
Intermediate Science (HSc) 2000
From St Joseph College
Karachi
A-Grade
SSC Examination 1998
From S.M Public School
A-One Grade
Internship____________________________
FROM 01-09 2006 TO 28-02-2007
Six month Internship in Gynae/OBS at JPMC
FROM 13-03-2007 TO 12-06-2007
Three month Internship in Medicine at JPMC
FROM 16-06-2007 TO 15-09-2007
Three month Internship in Neurology at JPMC
Working Experience_____________________
FROM 26th June 2010 To Till Date
Currently I am working in Dr. Sulaiman Al-Habib medical group-olaya as a medical claim and rejection examiner.
JOB RESPONSIBILITES:
To manage the work of business office staff; claims reviewing, rejections, reconciliation, business reports and making sure that all the insurance and private claims are processed and finalized with the insurance companies.
1. Claims Examining
1.1 Reviewing and approving claims (both insurance & private) before submission to their respective companies.
1.2 Case investigation whenever and wherever required (in cases of excessive, unjustified or excluded services).
2. Rejection Reviewing & Re explanation
2.1 Review claims rejection.
2.2 Prepare answers/justifications for rejected claims.
2.3 Co-ordinate with physicians regarding re explanation on rejected claims.
3. Reconciliation
3.1 Performs reconciliation with companies and hospital.
3.2Attends meetings for reconciliation with companies along with the Business Service Director.
4. Medical Reports & other affairs
4.1 Prepare medical reports as per insurance companies’ criteria.
4.2 Perform other tasks and duties assigned within the realm of my knowledge, skills and abilities.
5. Business Reports and Management
5.1 Managing business reporting of insurance and private companies for monthly, quarterly, half yearly and annual group meetings.
5.2 Managing the work of business office staff.
5.3 Preparing and delivering presentations related to various critical illnesses and surgical procedures.
5.4 Give orientation to doctors related to insurance criteria
6. Orientation to consultants
6.1 Giving orientation to consultation related to insurance policies and criteria
FROM 2nd Feb 2009 To Till Date
I am working in Asia Care Health And Life Insurance Company as a Medical Manager.
FROM 20TH FEB 2008 TO 31ST JAN 2009:
Worked as a Senior Medical officer in Adamjee insurance company
JOB RESPONSIBILITES:
Intimation approval
Evaluation of Reimbursement, Hospital & OPD claims.
Closing/Processing of claims as per policies of all clients.
Contact development with different hospitals and Clients.
Check OPD claims medically and enter data in system.
Maintaining of records of hospitals enlisted and hospitals other than panel hospital.
Check validitation of hospital rates.
Verify/compare different medical and surgical procedures being undertaken in different hospitals.
Maintain relationship with hospitals.
Negotiate and maintain hospital rates.
Interaction with branches about claim queries.
FROM 01-AUG 2007 TO 15 –FEB 2008
Worked as a RMO in City Medical Center. Where I am responsible for seeing
Patients in Ward, Emergency & ICU. I was managed emergency patients independently and treat ward patients. I also delivered baby in labor room independently. Also assist consultants in OPD.
I was also cleared ARMY ISSB test and interview.
SKILLS AND SPEIFIC STRENGTHS
Ability to handle Emergencies (Accident & Emergency cases) well.
Good diagnostic skills, treatment planning and execution proficiency.
Outstanding bedside manner - Strong interpersonal and relationship building skills.
Dedicated to providing safe, efficient and patient – centered care.
Able to put patients at ease and good counseling skills.
Personable, competent and team-spirited – work in harmony with medical staff, administration, patient, and family members to ensure high quality medical attention consistent with organizational standard operating procedures.
Effective troubleshooting and problem solving skills in fast track, high stress (life/ death) environments.
Clinically sound incorporating good decision-making skills.
Ability to deliver effective presentations.
Well-skilled in using the computer, MS Word, MS Power Point and browsing the internet.
Presentation / Seminar _________________
Attended Seminar on
Cardiology 2006
Regent Plaza, Karachi
Gave a Presentation on Breast Feeding and its advantages
on gyane/obs tutorial in (ward 9) 2006
Gave a Bedside Presentation (Post-EM Call) on
Hepatic Cirrhosis Medicine Unit II (Ward 6) 2007
Attended
the 45th Annual Medical Symposium April 28 – 30, 2008
Theme : Health for the Under Privileged
JPMC, Karachi
Community Work____________________
During my MBBS I did Community work with WHO for campaign of POLIO
EPI & HEPATITS.
Computer Skills_________________________
Windows. MS Office (Word / Excel / Power Point). Internet.
Extra curricular Activities________________.
Reading Medical Journal
Gardening
Sports
Teaching (Clinical Instructions to Undergraduate Medical Students 3rd, 4th and final yr students; Neuroanatomy to 2nd yr students from SMC. Teaching Biology and mathematics to O and A level students)
Personal Details
Father Name Javed Akhter
Date of Birth 22ndNov 1981
Status Married
Religion Islam
Nationality Pakistani
PMDC No 51491-S
REFERENCES:
Dr. M. Khaleeq Warsi , Family Physician of AKHSP.
Dr. Ikram, Physician in Ziauddin Memorial Hospital.
Dr. Asad Qamar, Medical Manager in Asiacare Health Insurance.
Dr. Asma Qaiser Qureshi, working in private clinic
Contact this candidate